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Scicchitano P, Massari F. The burden of congestion monitoring in acute decompensated heart failure: The need for multiparametric approach. IJC HEART & VASCULATURE 2024; 54:101491. [PMID: 39224459 PMCID: PMC11367631 DOI: 10.1016/j.ijcha.2024.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
| | - Francesco Massari
- Cardiology Section, Hospital “F. Perinei” ASL BA, Altamura, Bari, Italy
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Gomes FKA, Fagundes AADP, Amorim FF. Cardiac Output and Stroke Volume Assessments by Transthoracic Echocardiography and Pulse index Continuous Cardiac Output Monitor in Critically ill Adult Patients: A Comparative Study. J Intensive Care Med 2024; 39:341-348. [PMID: 37769347 DOI: 10.1177/08850666231204787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE Bedside transthoracic echocardiography (TTEcho) is a noninvasive cardiac output (CO) monitoring method that has grown recently. However, there are questions regarding its accuracy compared to invasive methods. We aimed to evaluate the agreement and correlation of TTEcho and pulse index continuous CO (PiCCO) monitor measurements for CO and systolic volume (SV) in critically ill patients. METHODS This prospective experimental study included consecutive adult patients who required invasive hemodynamic monitoring admitted at an intensive care unit in the Federal District, Brazil, from January/2019 to January/2021. Correlation and agreement between SV and CO measurements by PiCCO and TTEcho were performed using the Spearman correlation and the Bland-Altman analysis. RESULTS The study enrolled 29 patients, with adequate TTEcho evaluations in all patients. There were very strong correlations between CO-TTEcho and CO-PiCCO (r = 0.845, P < .001) and SV-TTEcho and SV-PiCCO (r = 0.800, P < .001). TTEcho estimations for CO and SV were feasible within the limits of agreement in 96.6% (28/29) compared to PiCCO. The mean difference between CO-PiCCO and CO-TTEcho was 0.250 L/min (limits of agreement: -1.083 to 1.583 L/min, percentage error: 21.0%), and between SV-PiCCO and SV-TTEcho was 2.000 mL (limits of agreement: -16.960 to 20.960, percentage error: 24.3%). The reduced cardiac index (CI) measurements by TTEcho showed an accuracy of 89.7% (95% IC: 72.6%-97.8%) and an F1 score of 92.7% (95% IC: 75.0%-98.0%), considering the CI-PiCCO as the gold standard. CONCLUSION Echocardiographic measurements of CO and SV are comparable to measurements by PiCCO. These results reinforce echocardiography as a reliable tool to evaluate hemodynamics in critically ill patients.
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Affiliation(s)
- Flávia K A Gomes
- Graduate Program in Health Sciences, Higher Education School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Adult Intensive Care Unit, Hospital DF Star, Brasília, Federal District, Brazil
- Adult Intensive Care Unit, Hospital Home, Brasília, Federal District, Brazil
| | | | - Fábio F Amorim
- Graduate Program in Health Sciences, Higher Education School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Graduate Program in Health Sciences, University of Brasilia (UnB), Brasília, Federal District, Brazil
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Li-ping Q, Hong-wei L, Chang-ming H, Yong-yi B, Ang L. Safety and efficacy of pulse-induced contour cardiac output monitoring in elderly patients with coronary artery disease and severe heart failure at coronary care units. Front Cardiovasc Med 2022; 9:910898. [DOI: 10.3389/fcvm.2022.910898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe optimal treatment for elderly patients with severe heart failure depends on the accurate assessment of their hemodynamic status. Due to its less invasive nature, the safety and efficacy of invasive pulse-induced contour cardiac output (PiCCO)-based hemodynamic monitoring remains uncertain.MethodsThis was a prospective observational study. Between January 2016 and July 2020, 190 elderly patients with severe heart failure were consecutively enrolled. The PiCCO group (89 patients) and non-invasive hemodynamic monitoring group (101 patients) were observed. Hospital stays results were evaluated.ResultsNo significant difference in clinical data (P > 0.05) or the incidence of 1-month mortality (16.0 vs. 35.0%, P = 0.141) were observed between groups. The coronary care unit (CCU) stay was shorter in the PiCCO group than in the non-invasive group (40.0 vs. 43.0%, P = 0.049). Indicators such as low Extravascular Lung Water Index (EVLWI), high Body Mass Index (BMI), low Pulmonary Artery Pressure (PAP), and high Left Ventricular Ejection Time (LVET), were associated with favorable clinical results.ConclusionEarly invasive PiCCO monitoring is safe in critically ill elderly patients with severe heart failure. The hospital stay was reduced using PiCCO monitoring. These encouraging PiCCO results favor its use in elderly patients with severe heart failure at CCUs.
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Li X, Tuerxun T, Xie Z, Ma L, Wang Y, Liu B, Yu X. Extravascular Lung Water and Intrathoracic Blood Volume Index Are Associated With Liver Function in Brain Dead Donors for Organ Transplant. EXP CLIN TRANSPLANT 2021; 19:450-456. [PMID: 33736588 DOI: 10.6002/ect.2020.0492] [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]
Abstract
OBJECTIVES Hemodynamic measurements during organ transplant procedures are essential. MATERIALS AND METHODS In this observational study, we measured clinical and hemodynamic parameters in 11 patients with advanced pulse indicator continuous cardiac output monitoring. Normally distributed clinical data were calculated as means ± standard deviation; hemodynamic, metabolic, and respiratory parameters related to liver and renal function were compared by linear regression analysis using Pearson correlation. RESULTS Compared with the normal range, systemic vascular resistance was high (2278.02 ± 719.6 dyne·s/cm²/m²) and intrathoracic blood volume was low (787.37 ± 224.01 mL/m²) in our patient group. C-reactive protein and interleukin 6 levels were 96.26 ± 68.10 mg/mL and 246.24 ± 355.74 mmol/L, respectively. Liver and renal function parameters were in normal ranges. Extravascular lung water was correlated with total, conjugated, and unconjugated bilirubin and albumin (r = 0.342/P = .005; r = 0.338/ P = .005; r = 0.394/P = .001, and r = 0.358/P = .003) but not with aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and serum creatinine. Intrathoracic blood volume index was correlated with total bilirubin, unconjugated bilirubin, and albumin (r = 0.324/P = .007; r = 0.394/P = .001, and r = 0.296/P = .015) but not with conjugated bilirubin, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and serum creatinine. Lactate was not correlated with total bilirubin, unconjugated bilirubin, albumin, and serum creatinine, but base excess was correlated with total bilirubin, unconjugated bilirubin, alanine aminotransferase, and albumin. PO₂ and Pco₂ were not correlated with liver function, although PO₂ was correlated with albumin. CONCLUSIONS No correlations were shown between intrathoracic blood volume index, extravascular lung water, and liver function, but metabolic parameters, including base excess and lactate, were correlated with liver function. Pulse indicator continuous cardiac output monitoring may be a useful method to assess organ function and tissue perfusion in organ transplant.
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Affiliation(s)
- Xiaopeng Li
- From the Department of Neurointensive Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Beijing
| | - Tuerhong Tuerxun
- From the Department of Neurointensive Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Beijing
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Abstract
PURPOSE OF REVIEW Adequate tissue perfusion is of utmost importance to avoid organ failure in patients with cardiogenic shock. Within the recent years, the microcirculation, defined as the perfusion of the smallest vessels, has been identified to play a crucial role. Microcirculatory changes may include capillary flow disturbances as well as changes in the density of perfused vessels. Due to the availability of new technologies to assess the microcirculation, interesting new data came up and it is the purpose of this review to summarize recent studies in the field. RECENT FINDINGS Nowadays, an increasing number of studies confirm parameters of the microcirculation, derived by intravital microscopy, to represent strong outcome predictors in cardiogenic shock. In addition, microcirculation as read-out parameter in innovative clinical studies has meanwhile been accepted as serious endpoint. Treatment strategies such as mechanical assist devices, blood pressure regulating agents or fluids use tissue perfusion and microcirculatory network density as targets in addition to clinical perfusion evaluation and decreasing serum lactate levels. SUMMARY The parameter most frequently used to detect tissue malperfusion is serum lactate. Novel, noninvasive methods to quantify microvascular perfusion have the potential to guide treatment in terms of optimizing organ perfusion and oxygenation probably paving the way for an individualized therapy.
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Werner M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM, Masyuk M, Schulze PC, Hoppe UC, Kelm M, Lauten A, Jung C. Real-world extravascular lung water index measurements in critically ill patients : Pulse index continuous cardiac output measurements: time course analysis and association with clinical characteristics. Wien Klin Wochenschr 2019; 131:321-328. [PMID: 31069475 DOI: 10.1007/s00508-019-1501-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/16/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pulse index continuous cardiac output (PiCCO) is used for hemodynamic assessment. This study describes real world extravascular lung water index (EVLWI) measurements at three time points and relates them to other hemodynamic parameters and mortality in critically ill patients admitted to a medical intensive care unit (ICU). METHODS A total of 198 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis. Patients were admitted for various diseases such as sepsis (n = 22), myocardial infarction (n = 53), pulmonary embolism (n = 3), cardiopulmonary resuscitation (n = 15), acute heart failure (AHF; n = 21) and pneumonia (n = 25). RESULTS Patients included in this analysis were severely ill as represented by the high simplified acute physiology score 2 (SAPS2, 42 ± 18) and acute physiology and chronic health evaluation score 2 (APACHE2' 22 ± 9). Real-world values at three time points are provided. Intra-ICU mortality rates did not differ between the EVLWI > 7 vs. the ELVWI < 7 groups (15% vs. 13%; p = 0.82) and no association between hemodynamic measurements obtained by PiCCO with long-term mortality could be shown. CONCLUSION There were no associations of any PiCCO measurements with mortality most probably due to selection bias towards severely ill patients. Future prospective studies with predefined inclusion criteria and treatment algorithms are necessary to evaluate the value of PiCCO for prediction of mortality against simple clinical tools such as jugular venous pressure, edema and auscultation.
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Affiliation(s)
- Matthias Werner
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bjoern Kabisch
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Paul Christian Schulze
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Extravascular lung water index and Halperin score to predict outcome in critically ill patients. Wien Klin Wochenschr 2018; 130:505-510. [PMID: 30094662 DOI: 10.1007/s00508-018-1370-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/15/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to describe real world extravascular lung water index (EVLWI) measurements obtained by pulse index continuous cardiac output (PiCCO) on the day of admission. These were then related to a radiologic score for lung edema, Halperin score and both the Halperin score and EVLWI were assessed for prediction of in-hospital mortality in critically ill patients. METHODS AND RESULTS A total of 311 patients admitted to a tertiary medical university hospital between February 2004 and December 2010 were included in this retrospective analysis and of these 177 patients were intubated. In-hospital mortality was assessed by logistic regression. In the overall cohort, EVLWI and the Halperin score correlated poorly (r = 0.17; p = 0.02). In intubated patients, EVLWI and Halperin score did not correlate (r = 0.09; p = 0.39), whereas in patients who were not intubated there was a moderate association (r = 0.30; p = 0.007). In the overall cohort, (a) EVLWI (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.19; p = 0.01; area under the curve [AUC] 0.63, 95% CI 0.54-0.71) but not (b) Halperin score (HR 1.00, 95% CI 0.996-1.004; p = 0.94; AUC 0.52, 95% CI 0.45-0.58) was associated with in-hospital mortality There was a robust association of EVLWI (HR 1.12, 95% CI 1.01-1.25; p = 0.03) but not Halperin score (HR 1.003, 95% CI 0.997-1.009; p = 0.30) with mortality in non-intubated patients. In intubated patients, neither EVLWI (HR 0.997 95% CI 0.990-1.003; p = 0.33) nor Halperin score (HR 1.08; 95% CI 0.88-1.32; p = 0.47) was associated with mortality. CONCLUSION The EVLWI correlated moderately with a radiologic score for lung edema, the Halperin score, in non-intubated but not in intubated patients. The EVLWI at admission was associated with in-hospital mortality in our patient collective of critically ill patients and might constitute not only a tool for risk stratification but most importantly a valuable treatment goal.
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Lichtenauer M, Wernly B, Paar V, Rohm I, Jung C, Yilmaz A, Hoppe UC, Schulze PC, Kretzschmar D, Pistulli R. Specifics of fetuin-A levels in distinct types of chronic heart failure. J Clin Lab Anal 2017; 32. [PMID: 28213903 DOI: 10.1002/jcla.22179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/21/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Fetuin-A has been described to correlate inversely with vascular calcification both in animal models but also in patients with heart and renal disease. In this current study, we sought to investigate whether fetuin-A might be a useful marker for the discrimination of ischemic (ICM) from dilated cardiomyopathy (DCM). METHODS A total of 124 non-consecutive patients were included in this study, 59 patients suffered from ICM and 65 patients from DCM. Serum samples were obtained during out-patient visits and analyzed for fetuin-A by ELISA. RESULTS Median fetuin-A concentration in the overall cohort was significantly lower in ICM patients compared to DCM patients (62.2±16.4 μg/mL vs. 129.6±56.6 μg/mL; P<.001). A positive correlation of fetuin-A levels was found with BMI, cholesterol, LDL/HDL ratio and triglycerides and an inverse correlation with age (r=-.36; P<.001). Moreover, patients suffering from (stable) angina pectoris evidenced lower fetuin-A levels compared to non-symptomatic patients (73.1±22.7 μg/mL vs. 83.7±26.2 μg/mL; P=.047) CONCLUSIONS: Fetuin-A was shown to be a potential discriminator and biomarker for the differential diagnosis between ICM and DCM. Fetuin-A levels might also be helpful in the process of diagnostic decision-making in regards to invasive management or medical therapy.
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Affiliation(s)
- Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ilonka Rohm
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Atilla Yilmaz
- Clinic of Internal Medicine II, Elisabeth Klinikum Schmalkalden, Schmalkalden, Germany
| | - Uta C Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Paul Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Rudin Pistulli
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
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