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Gao Y, Yin H, Wang MH, Gao YH. Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis. Front Pediatr 2023; 11:1211306. [PMID: 37744441 PMCID: PMC10511769 DOI: 10.3389/fped.2023.1211306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although lung and diaphragm ultrasound are valuable tools for predicting weaning results in adults with MV, their relevance in children is debatable. The goal of this meta-analysis was to determine the predictive value of lung and diaphragm ultrasound in newborn weaning outcomes. Methods For eligible studies, the databases MEDLINE, Web of Science, Cochrane Library, PubMed, and Embase were thoroughly searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to evaluate the study's quality. Results were gathered for sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve of summary receiver operating characteristic curves (AUSROC). To investigate the causes of heterogeneity, subgroup analyses and meta-regression were conducted. Results A total of 11 studies were suitable for inclusion in the meta-analysis, which included 828 patients. The pooled sensitivity and specificity of lung ultrasound (LUS) were 0.88 (95%CI, 0.85-0.90) and 0.81 (95%CI, 0.75-0.87), respectively. The DOR for diaphragmatic excursion (DE) is 13.17 (95%CI, 5.65-30.71). The AUSROC for diaphragm thickening fraction (DTF) is 0.86 (95%CI, 0.82-0.89). The most sensitive and specific method is LUS. The DE and DTF were the key areas where study heterogeneity was evident. Conclusions Lung ultrasonography is an extremely accurate method for predicting weaning results in MV infants. DTF outperforms DE in terms of diaphragm ultrasound predictive power.
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Affiliation(s)
- Yang Gao
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Hong Yin
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Mei-Huan Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yue-Hua Gao
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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2
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Corcoran E, Hopkins P, Fisher R, Wong A, Rose L. Intensive care nurse-led point of care ultrasound in the assessment and management of the critically ill COVID-19 patient: A single centre case series. Nurs Crit Care 2023; 28:781-788. [PMID: 36575807 PMCID: PMC9880746 DOI: 10.1111/nicc.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
Focused ultrasound can be used to rapidly diagnose COVID-19 disease, assess disease severity, and inform management of COVID-19 and associated pathologies, reducing radiation exposure from other imaging modalities and minimizing spread of infection. Ultrasound examinations performed by trained nurses in the intensive care unit (ICU) enable more patients to receive these assessments. This case series evaluates the use of nurse-led focused cardiac and lung ultrasound for clinical management of ICU patients with COVID-19. We describe common pathophysiological findings and how findings were used to inform clinical decision-making. An ultrasound trained ICU nurse performed Focused Ultrasound in Intensive Care (FUSIC) cardiac and lung scans enabling calculation of a lung severity score on adult ICU patients with a confirmed COVID-19 diagnosis in a single-centre setting. Fifteen scans were performed on 15 patients. Thirteen (87%) patients had normal left ventricular function; 12 (80%) normal right ventricular function. All 15 (100%) scans identified abnormal lung findings including irregular thickened pleura, B-lines, sub-pleural consolidation and hepatization. Worse lung severity scores were correlated with higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores (r = 0.70; p = .003). Of the 15 scans, 10 (67%) identified abnormal pathology contributing to a change in clinical management. This included targeted fluid removal (4, 27%), change in respiratory management (3, 20%) and need for formal echocardiographic assessment (3, 20%). Findings from five (33%) scans required no intervention. This case series demonstrates nurse-led ultrasound could be a useful adjunct in the management of the COVID-19 patient.
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Affiliation(s)
| | - Phil Hopkins
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Richard Fisher
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Adrian Wong
- Intensive Care Research TeamKing's College HospitalLondonUK
| | - Louise Rose
- Intensive Care Research TeamKing's College HospitalLondonUK
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3
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Zampieri FG, Bagshaw SM, Semler MW. Fluid Therapy for Critically Ill Adults With Sepsis: A Review. JAMA 2023; 329:1967-1980. [PMID: 37314271 DOI: 10.1001/jama.2023.7560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Importance Approximately 20% to 30% of patients admitted to an intensive care unit have sepsis. While fluid therapy typically begins in the emergency department, intravenous fluids in the intensive care unit are an essential component of therapy for sepsis. Observations For patients with sepsis, intravenous fluid can increase cardiac output and blood pressure, maintain or increase intravascular fluid volume, and deliver medications. Fluid therapy can be conceptualized as 4 overlapping phases from early illness through resolution of sepsis: resuscitation (rapid fluid administered to restore perfusion); optimization (the risks and benefits of additional fluids to treat shock and ensure organ perfusion are evaluated); stabilization (fluid therapy is used only when there is a signal of fluid responsiveness); and evacuation (excess fluid accumulated during treatment of critical illness is eliminated). Among 3723 patients with sepsis who received 1 to 2 L of fluid, 3 randomized clinical trials (RCTs) reported that goal-directed therapy administering fluid boluses to attain a central venous pressure of 8 to 12 mm Hg, vasopressors to attain a mean arterial blood pressure of 65 to 90 mm Hg, and red blood cell transfusions or inotropes to attain a central venous oxygen saturation of at least 70% did not decrease mortality compared with unstructured clinical care (24.9% vs 25.4%; P = .68). Among 1563 patients with sepsis and hypotension who received 1 L of fluid, an RCT reported that favoring vasopressor treatment did not improve mortality compared with further fluid administration (14.0% vs 14.9%; P = .61). Another RCT reported that among 1554 patients in the intensive care unit with septic shock treated with at least 1 L of fluid compared with more liberal fluid administration, restricting fluid administration in the absence of severe hypoperfusion did not reduce mortality (42.3% vs 42.1%; P = .96). An RCT of 1000 patients with acute respiratory distress during the evacuation phase reported that limiting fluid administration and administering diuretics improved the number of days alive without mechanical ventilation compared with fluid treatment to attain higher intracardiac pressure (14.6 vs 12.1 days; P < .001), and it reported that hydroxyethyl starch significantly increased the incidence of kidney replacement therapy compared with saline (7.0% vs 5.8%; P = .04), Ringer lactate, or Ringer acetate. Conclusions and Relevance Fluids are an important component of treating patients who are critically ill with sepsis. Although optimal fluid management in patients with sepsis remains uncertain, clinicians should consider the risks and benefits of fluid administration in each phase of critical illness, avoid use of hydroxyethyl starch, and facilitate fluid removal for patients recovering from acute respiratory distress syndrome.
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Affiliation(s)
- Fernando G Zampieri
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Learning Healthcare, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Yoshida T, Yoshida T, Noma H, Nomura T, Suzuki A, Mihara T. Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis. Crit Care 2023; 27:200. [PMID: 37231510 DOI: 10.1186/s13054-023-04495-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Circulatory failure is classified into four types of shock (obstructive, cardiogenic, distributive, and hypovolemic) that must be distinguished as each requires a different treatment. Point-of-care ultrasound (POCUS) is widely used in clinical practice for acute conditions, and several diagnostic protocols using POCUS for shock have been developed. This study aimed to evaluate the diagnostic accuracy of POCUS in identifying the etiology of shock. METHODS We conducted a systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Clinicaltrial.gov, European Union Clinical Trials Register, WHO International Clinical Trials Registry Platform, and University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) until June 15, 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was conducted to pool the diagnostic accuracy of POCUS for each type of shock. The study protocol was prospectively registered in UMIN-CTR (UMIN 000048025). RESULTS Of the 1553 studies identified, 36 studies were full-text reviewed, and 12 studies with 1132 patients were included in the meta-analysis. Pooled sensitivity and specificity were 0.82 [95% confidence interval (CI) 0.68-0.91] and 0.98 [95% CI 0.92-0.99] for obstructive shock, 0.78 [95% CI 0.56-0.91] and 0.96 [95% CI 0.92-0.98] for cardiogenic shock, 0.90 [95% CI 0.84-0.94] and 0.92 [95% CI 0.88-0.95] for hypovolemic shock, and 0.79 [95% CI 0.71-0.85] and 0.96 [95% CI 0.91-0.98] for distributive shock, respectively. The area under the receiver operating characteristic curve for each type of shock was approximately 0.95. The positive likelihood ratios for each type of shock were all greater than 10, especially 40 [95% CI 11-105] for obstructive shock. The negative likelihood ratio for each type of shock was approximately 0.2. CONCLUSIONS The identification of the etiology for each type of shock using POCUS was characterized by high sensitivity and positive likelihood ratios, especially for obstructive shock.
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Affiliation(s)
- Takuo Yoshida
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
- Department of Emergency Medicine, Jikei University School of Medicine, Minato-ku, 105-8471, Japan
| | - Takuya Yoshida
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tachikawa, 190-8562, Japan
| | - Takeshi Nomura
- Department of Perioperative Medical Support, Tokushukai Medical Corporation, Chiyoda-ku, 102-0074, Japan
| | - Akihiro Suzuki
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke, 329-0498, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan.
- Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, 236-0004, Japan.
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La Via L, Merola F, Schembari G, Liotta C, Sanfilippo F. The interplay between left ventricular diastolic and right ventricular dysfunction: challenges in the interpretation of critical care echocardiography studies. Egypt Heart J 2023; 75:7. [PMID: 36692697 PMCID: PMC9872744 DOI: 10.1186/s43044-023-00333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sepsis is a leading cause of death and it is characterized not only by profound vasoplegia but also by myocardial dysfunction. Critical care echocardiography is the preferred modality for the initial assessment of the cause of shock. Moreover, it can be extremely helpful in the identification of progressing myocardial dysfunction during the course of sepsis, also known as septic cardiomyopathy. MAIN BODY One of the issues in the identification of septic cardiomyopathy is that it can be manifest with different clinical phenotypes, from overt biventricular dysfunction to isolated left ventricular (LV) systolic and/or diastolic dysfunction, from right ventricular (RV) systolic dysfunction to RV failure and dilatation. However, the commonly used echocardiography parameters for the assessment of LV and/or RV function are not always entirely reliable. Indeed, these are influenced by variable preload and afterload conditions imposed by critical illness such as fluid shifts, sedation level and mechanical ventilation with positive pressure. CONCLUSIONS Strain echocardiography is a promising tool for the early identification of myocardial dysfunction in the context of sepsis. Studies reporting data on strain echocardiography should be particularly detailed in order to increase the reproducibility of results and to favor comparison with future studies.
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Affiliation(s)
- Luigi La Via
- grid.412844.f0000 0004 1766 6239Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy ,grid.8158.40000 0004 1757 1969School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Federica Merola
- grid.8158.40000 0004 1757 1969School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Giovanni Schembari
- grid.411489.10000 0001 2168 2547School of Anesthesia and Intensive Care, University “Magna Graecia”, Catanzaro, Italy
| | - Calogero Liotta
- grid.411489.10000 0001 2168 2547School of Anesthesia and Intensive Care, University “Magna Graecia”, Catanzaro, Italy
| | - Filippo Sanfilippo
- grid.412844.f0000 0004 1766 6239Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy ,grid.8158.40000 0004 1757 1969Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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6
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Banai A, Lupu L, Shetrit A, Hochstadt A, Lichter Y, Levi E, Szekely Y, Schellekes N, Jacoby T, Zahler D, Itach T, Taieb P, Gefen S, Viskin D, Shidlansik L, Adler A, Levitsky E, Havakuk O, Banai S, Ghantous E, Topilsky Y. Systematic lung ultrasound in Omicron-type vs. wild-type COVID-19. Eur Heart J Cardiovasc Imaging 2022; 24:59-67. [PMID: 36288539 PMCID: PMC9620376 DOI: 10.1093/ehjci/jeac212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Preliminary data suggested that patients with Omicron-type-Coronavirus-disease-2019 (COVID-19) have less severe lung disease compared with the wild-type-variant. We aimed to compare lung ultrasound (LUS) parameters in Omicron vs. wild-type COVID-19 and evaluate their prognostic implications. METHODS AND RESULTS One hundred and sixty-two consecutive patients with Omicron-type-COVID-19 underwent LUS within 48 h of admission and were compared with propensity-matched wild-type patients (148 pairs). In the Omicron patients median, first and third quartiles of the LUS-score was 5 [2-12], and only 9% had normal LUS. The majority had either mild (≤5; 37%) or moderate (6-15; 39%), and 15% (≥15) had severe LUS-score. Thirty-six percent of patients had patchy pleural thickening (PPT). Factors associated with LUS-score in the Omicron patients included ischaemic-heart-disease, heart failure, renal-dysfunction, and C-reactive protein. Elevated left-filling pressure or right-sided pressures were associated with the LUS-score. Lung ultrasound-score was associated with mortality [odds ratio (OR): 1.09, 95% confidence interval (CI): 1.01-1.18; P = 0.03] and with the combined endpoint of mortality and respiratory failure (OR: 1.14, 95% CI: 1.07-1.22; P < 0.0001). Patients with the wild-type variant had worse LUS characteristics than the matched Omicron-type patients (PPT: 90 vs. 34%; P < 0.0001 and LUS-score: 8 [5, 12] vs. 5 [2, 10], P = 0.004), irrespective of disease severity. When matched only to the 31 non-vaccinated Omicron patients, these differences were attenuated. CONCLUSION Lung ultrasound-score is abnormal in the majority of hospitalized Omicron-type patients. Patchy pleural thickening is less common than in matched wild-type patients, but the difference is diminished in the non-vaccinated Omicron patients. Nevertheless, even in this milder form of the disease, the LUS-score is associated with poor in-hospital outcomes.
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Affiliation(s)
| | | | - Aviel Shetrit
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Yael Lichter
- The Intensive Care Unit, Tel-Aviv Sourasky Medical Center and Sackler school of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Erez Levi
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Nadav Schellekes
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Tammy Jacoby
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Tamar Itach
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Philippe Taieb
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Sheizaf Gefen
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Lia Shidlansik
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ekaterina Levitsky
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Weizmann 6, Tel Aviv 6423919, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University,Weizmann 6, Tel Aviv 6423919, Israel
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Chotalia M, Ali M, Hebballi R, Singh H, Parekh D, Bangash MN, Patel JM. Hyperdynamic Left Ventricular Ejection Fraction in ICU Patients With Sepsis. Crit Care Med 2022; 50:770-779. [PMID: 34605779 DOI: 10.1097/ccm.0000000000005315] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the cause and prognosis of hyperdynamic left ventricular ejection fraction in critically ill patients with sepsis. DESIGN Retrospective, single-center cohort study. SETTING University Hospital ICU, Birmingham, United Kingdom. PATIENTS ICU patients who received a transthoracic echocardiogram within 7 days of sepsis between April 2016 and December 2019. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS The 90-day mortality rates of normal (55-70%), depressed (< 55%), and hyperdynamic left ventricular ejection fraction (> 70%) were compared. Multivariate logistic regression analysis was performed to determine the association of left ventricular ejection fraction phenotypes with mortality and the association of clinical variables with left ventricular ejection fraction phenotypes. One thousand fourteen patients met inclusion criteria and were 62 years old (interquartile range, 47-72), with mostly respiratory infections (n = 557; 54.9%). Ninety-day mortality was 32.1% (n = 325). Patients with hyperdynamic left ventricular ejection fraction had a higher mortality than depressed and normal left ventricular ejection fraction cohorts (58.9% [n = 103] vs 34.0% [n = 55] vs 24.7% [n = 167]; p < 0.0001, respectively). After multivariate logistic regression, hyperdynamic left ventricular ejection fraction was independently associated with mortality (odds ratio, 3.90 [2.09-7.40]), whereas depressed left ventricular ejection fraction did not (odds ratio, 0.62 [0.28-1.37]). Systemic vascular resistance was inversely associated with hyperdynamic left ventricular ejection fraction (odds ratio, 0.79 [0.58-0.95]), and age, frailty, and ischemic heart disease were associated with depressed left ventricular ejection fraction. CONCLUSIONS Hyperdynamic left ventricular ejection fraction was associated with mortality in septic ICU patients and may reflect unmitigated vasoplegia from sepsis. Depressed left ventricular ejection fraction was not associated with mortality but was associated with cardiovascular disease.
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Affiliation(s)
- Minesh Chotalia
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Muzzammil Ali
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Ravi Hebballi
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Harjot Singh
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Mansoor N Bangash
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jaimin M Patel
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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8
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Berger D, Wigger O, de Marchi S, Grübler MR, Bloch A, Kurmann R, Stalder O, Bachmann KF, Bloechlinger S. The effects of positive end-expiratory pressure on cardiac function: a comparative echocardiography-conductance catheter study. Clin Res Cardiol 2022; 111:705-719. [PMID: 35381904 PMCID: PMC9151717 DOI: 10.1007/s00392-022-02014-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023]
Abstract
Background Echocardiographic parameters of diastolic function depend on cardiac loading conditions, which are altered by positive pressure ventilation. The direct effects of positive end-expiratory pressure (PEEP) on cardiac diastolic function are unknown. Methods Twenty-five patients without apparent diastolic dysfunction undergoing coronary angiography were ventilated noninvasively at PEEPs of 0, 5, and 10 cmH2O (in randomized order). Echocardiographic diastolic assessment and pressure–volume-loop analysis from conductance catheters were compared. The time constant for pressure decay (τ) was modeled with exponential decay. End-diastolic and end-systolic pressure volume relationships (EDPVRs and ESPVRs, respectively) from temporary caval occlusion were analyzed with generalized linear mixed-effects and linear mixed models. Transmural pressures were calculated using esophageal balloons. Results τ values for intracavitary cardiac pressure increased with the PEEP (n = 25; no PEEP, 44 ± 5 ms; 5 cmH2O PEEP, 46 ± 6 ms; 10 cmH2O PEEP, 45 ± 6 ms; p < 0.001). This increase disappeared when corrected for transmural pressure and diastole length. The transmural EDPVR was unaffected by PEEP. The ESPVR increased slightly with PEEP. Echocardiographic mitral inflow parameters and tissue Doppler values decreased with PEEP [peak E wave (n = 25): no PEEP, 0.76 ± 0.13 m/s; 5 cmH2O PEEP, 0.74 ± 0.14 m/s; 10 cmH2O PEEP, 0.68 ± 0.13 m/s; p = 0.016; peak A wave (n = 24): no PEEP, 0.74 ± 0.12 m/s; 5 cmH2O PEEP, 0.7 ± 0.11 m/s; 10 cmH2O PEEP, 0.67 ± 0.15 m/s; p = 0.014; E’ septal (n = 24): no PEEP, 0.085 ± 0.016 m/s; 5 cmH2O PEEP, 0.08 ± 0.013 m/s; 10 cmH2O PEEP, 0.075 ± 0.012 m/s; p = 0.002]. Conclusions PEEP does not affect active diastolic relaxation or passive ventricular filling properties. Dynamic echocardiographic filling parameters may reflect changing loading conditions rather than intrinsic diastolic function. PEEP may have slight positive inotropic effects. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02267291, registered 17. October 2014. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02014-1.
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Affiliation(s)
- David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Olivier Wigger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin R Grübler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Zentrum Für Intensivmedizin, Kantonsspital Luzern, Luzern, Switzerland
| | - Reto Kurmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Luzern, Luzern, Switzerland
| | | | - Kaspar Felix Bachmann
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Zentrum Für Intensivmedizin, Kantonsspital Luzern, Luzern, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital,, University of Bern, Bern, Switzerland
| | - Stefan Bloechlinger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Klinik Für Kardiologie, Kantonsspital Winterthur, Winterthur, Switzerland
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9
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Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med 2022; 48:1429-1438. [PMID: 35941260 PMCID: PMC9360728 DOI: 10.1007/s00134-022-06804-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Affiliation(s)
- Paul H. Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- AP-HP Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010 Créteil, France ,Univ Paris Est Créteil, CARMAS, 94010 Créteil, France ,Univ Paris Est Créteil, INSERM, IMRB, 94010 Créteil, France
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France
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10
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Zaki A, El Ghawaby HH, Gad MMM, Ismail AM, Nawar AS. Diaphragmatic Function Assessed by Bed Side Ultrasonography in Patients with Sepsis or Septic Shock Admitted to Intensive Care Unit. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sepsis and septic shock are major problems faced the healthcare systems all over the world every year. The ultrasound (US) is a simple, non-invasive, easily accessible technique, and showed great accuracy in diaphragm assessment.
AIM: We evaluated the diaphragmatic function assessed by US in patients with sepsis and septic shock and correlated these assessments with different parameters.
MATERIALS AND METHODS: A prospective observational study carried out on 30 patients admitted to the intensive care unit (ICU) diagnosed with sepsis and/or septic shock. Both diaphragmatic excursion (DE) and thickness fraction (diaphragm thickening fraction [TDI] %) were assessed by US on admission and every 48 h along the patients’ ICU stay.
RESULTS: In the current study, there was a statistically significant reverse relationship between mortality and the different diaphragmatic function parameters (DE on admission, average DE, on admission TDI%, average TDI%). On the other hand, the DE (on admission and average) showed a statistically significant reverse relation with the need and duration of mechanical ventilation (MV) while the TDI% showed a statistically significant reverse relation only with the duration of MV. Besides, there was a statistically significant direct relationship between successful weaning from MV and all the measured parameters.
CONCLUSION: We proposed that the diaphragmatic function parameters (DE on admission, average DE, on admission TDI% and average TDI%) assessed by US of septic ICU patients could be used as a predictor of the need, duration, and successful weaning from MV and also as a predictor of mortality.
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11
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Gillmann HJ, Dieding J, Schrimpf C, Janssen H, Sahlmann B, Rustum S, Aper T, Lichtinghagen R, Teebken OE, Theilmeier G, Larmann J. Prospective evaluation of preoperative lung ultrasound for prediction of perioperative outcome and myocardial injury in adult patients undergoing vascular surgery (LUPPO study). Minerva Anestesiol 2020; 86:1151-1160. [DOI: 10.23736/s0375-9393.20.14393-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Walter JM, Satterwhite L, Lyn-Kew KE. POINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? Yes. Chest 2020; 157:496-498. [PMID: 32145805 DOI: 10.1016/j.chest.2019.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- James M Walter
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Lewis Satterwhite
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Kenneth E Lyn-Kew
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO
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13
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Lichter Y, Topilsky Y, Taieb P, Banai A, Hochstadt A, Merdler I, Gal Oz A, Vine J, Goren O, Cohen B, Sapir O, Granot Y, Mann T, Friedman S, Angel Y, Adi N, Laufer-Perl M, Ingbir M, Arbel Y, Matot I, Szekely Y. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med 2020; 46:1873-1883. [PMID: 32860069 PMCID: PMC7454549 DOI: 10.1007/s00134-020-06212-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
Purpose Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome. Methods Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)—36 (worst) was assigned to each patient. LUS findings were compared with clinical data. Results The median baseline total LUS score was 15, IQR [7–20]. Baseline LUS score was 0–18 in 80 (67%) patients, and 19–36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0–18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02–1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05–1.2], p = 0.0008. Conclusion Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients’ management strategies, as well as resource allocation in case of surge capacity. Electronic supplementary material The online version of this article (10.1007/s00134-020-06212-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yael Lichter
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Taieb
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Banai
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Merdler
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Gal Oz
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Vine
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Goren
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Cohen
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Sapir
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Granot
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Mann
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirley Friedman
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Angel
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Adi
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ingbir
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Matot
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishay Szekely
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Cardiology, Tel Aviv Medical Center, Weizmann 6, 6423919, Tel Aviv, Israel.
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14
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Huang S, Sanfilippo F, Herpain A, Balik M, Chew M, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel. Ann Intensive Care 2020; 10:49. [PMID: 32335780 PMCID: PMC7183522 DOI: 10.1186/s13613-020-00662-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. Methods We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other “topic-specific” items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. Results From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. Conclusion This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.
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Affiliation(s)
- S Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - F Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - A Herpain
- Department of Intensive Care, Erasme University Hospital, Univeristé Libre de Bruxelles, Brussels, Belgium
| | - M Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Chew
- Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - D De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - N Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - G Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - A Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - A McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - A Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - S Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - T Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - M Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - I C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - P Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Inserm CIC 1435, Limoges, France
| | - P Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - A Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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15
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Lemarié J, Maigrat CH, Kimmoun A, Dumont N, Bollaert PE, Selton-Suty C, Gibot S, Huttin O. Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study. Ann Intensive Care 2020; 10:24. [PMID: 32056017 PMCID: PMC7018922 DOI: 10.1186/s13613-020-0636-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients. RESULTS Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. CONCLUSIONS Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.
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Affiliation(s)
- Jérémie Lemarié
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France.
| | - Charles-Henri Maigrat
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Nathalie Dumont
- Plateforme d'Aide à la Recherche Clinique, Bâtiment Recherche, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
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Abdelhafeez RM, Abumossalam AM, Arram EO, Elshafey MM, Abushehata ME. Diaphragm and weaning from mechanical ventilation: anticipation and outcome. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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A practical approach to critical care ultrasound. J Crit Care 2019; 51:156-164. [DOI: 10.1016/j.jcrc.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
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18
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Harford M, Clark SH, Smythe JF, Gerry S, Villarroel M, Jorge J, Chaichulee S, Tarassenko L, Young D, Watkinson P. Non-invasive stroke volume estimation by transthoracic electrical bioimpedance versus Doppler echocardiography in healthy volunteers. J Med Eng Technol 2019; 43:33-37. [PMID: 30983444 PMCID: PMC6550124 DOI: 10.1080/03091902.2019.1599074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Thoracic electrical bioimpedance (TEB) and transthoracic echocardiography (TTE) are non-invasive methods to estimate stroke volume (SV) and cardiac output (CO). Thoracic electrical bioimpedance is not in widespread clinical use with reports of inaccurate cardiac output estimation compared to invasive monitors, particularly in non-healthy populations. We explore its use as a trend monitor by comparing it against thoracic echocardiography in fifteen healthy volunteers undergoing two physical challenges designed to vary cardiac output. Of all paired values, 54.6% showed gross trend agreement and only 1.9% showed direct disagreement between the two monitors. Our results show thoracic bioimpedance may have a role as a non-invasive cardiac output trend monitor in healthy volunteer studies.
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Affiliation(s)
- Mirae Harford
- a Critical Care Research Group, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK.,b Department of Engineering Science, Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Samuel H Clark
- c Critical Care Department , University College London Hospitals NHS Foundation Trust , London , UK
| | - Jodie F Smythe
- d Adult Intensive Care Unit , John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
| | - Stephen Gerry
- e Centre for Statistics in Medicine , University of Oxford , Oxford , UK
| | - Mauricio Villarroel
- b Department of Engineering Science, Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Joao Jorge
- b Department of Engineering Science, Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Sitthichok Chaichulee
- b Department of Engineering Science, Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Lionel Tarassenko
- b Department of Engineering Science, Institute of Biomedical Engineering , University of Oxford , Oxford , UK
| | - Duncan Young
- a Critical Care Research Group, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
| | - Peter Watkinson
- a Critical Care Research Group, Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45:770-788. [DOI: 10.1007/s00134-019-05604-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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20
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UltraNurse: teaching point-of-care ultrasound to intensive care nurses. Intensive Care Med 2019; 45:727-729. [PMID: 30725136 DOI: 10.1007/s00134-018-05512-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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21
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Cardiovascular focus editorial ICM 2018. Intensive Care Med 2018; 44:1995-1996. [PMID: 30284636 DOI: 10.1007/s00134-018-5396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
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22
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Singh K, Mayo P. Transthoracic echocardiography and mortality in sepsis: are we there yet? Intensive Care Med 2018; 44:1342-1343. [PMID: 29943086 DOI: 10.1007/s00134-018-5261-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Karan Singh
- Division of Pulmonary-Critical Care, Northwell Health, 410 Lakeville Road, Suite 107, New Hyde Park, NY, 11042, USA.
| | - Paul Mayo
- Division of Pulmonary-Critical Care, Northwell Health, 410 Lakeville Road, Suite 107, New Hyde Park, NY, 11042, USA
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23
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Shrestha GS, Upadhyay B, Shahi A, Jaya Ram KC, Joshi P, Poudyal BS. Sonographic Measurement of Optic Nerve Sheath Diameter: How Steep is the Learning Curve for a Novice Operator? Indian J Crit Care Med 2018; 22:646-649. [PMID: 30294130 PMCID: PMC6161582 DOI: 10.4103/ijccm.ijccm_104_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Transbulbar sonography for measuring optic nerve sheath diameter (ONSD) is noninvasive bedside technique for detection of raised intracranial pressure. This study aims to evaluate the number of sonographic evaluations required for a novice operator to learn proper measurement of ONSD after a formal training and supervised scanning session. Methods Three novice operators and one expert operator measured ONSD of 27 healthy volunteers using linear array transducer HFL38x (frequency range of 6-13 MHz) (MicroMaxx®; SonoSite, USA). In each eye, ONSD was measured three times by each observer and mean value was determined. Correlation coefficient was calculated between the novice and the experienced operator and in between the novice operators. Number of scans, after which the significant correlation developed between novice and the experienced operator and between the novice operators, was analyzed. Results Cronbach's alpha was tested to evaluate the reliability of the values obtained from intra- and interobservations. For all 27 cases, the value of Cronbach's alpha was high: 0.80-0.99 for the right eye and 0.69-0.97 for the left eye. The mean interobserver variations were plotted on a graph which fluctuated largely in the first 17 cases but oscillated around 0.5-0.30 in the last 10 cases. Conclusion Learning curve for novice operators to measure ONSD is steep and they can be taught to measure ONSD in healthy volunteers by sonography in supervised clinical session with an acceptable clinical precision and accuracy comparable to an experienced operator.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Binayak Upadhyay
- Department of Critical Care, Alka Hospital Private Limited, Jawalakhel, Lalitpur, Nepal
| | - Aanchal Shahi
- Department of Critical Care, Alka Hospital Private Limited, Jawalakhel, Lalitpur, Nepal
| | - K C Jaya Ram
- Department of Critical Care, Alka Hospital Private Limited, Jawalakhel, Lalitpur, Nepal
| | - Pankaj Joshi
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bishesh Sharma Poudyal
- Department of Clinical Hematology and Bone Marrow Transplant Unit, Civil Service Hospital, Kathmandu, Nepal
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Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and Lung Ultrasound to Predict Weaning Outcome. Chest 2017; 152:1140-1150. [DOI: 10.1016/j.chest.2017.08.028] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/24/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022] Open
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Shrestha GS. Point-of-care ultrasonography: a practical step in the path to precision in critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:215. [PMID: 28814346 PMCID: PMC5559801 DOI: 10.1186/s13054-017-1802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gentle Sunder Shrestha
- Department of Anaesthesiology, Critical Care Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
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