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Trauzeddel RF, Ertmer M, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter D, Scheeren TWL, Berger C, Treskatsch S. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography. J Clin Monit Comput 2021; 35:229-243. [PMID: 32458170 PMCID: PMC7943502 DOI: 10.1007/s10877-020-00534-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.
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Affiliation(s)
- R. F. Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M. Ertmer
- Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - M. Nordine
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H. V. Groesdonk
- Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Hospital Erfurt, Erfurt, Germany
| | - G. Michels
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R. Pfister
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D. Reuter
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - T. W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - C. Berger
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Marra AM, Bossone E, Salzano A, D’Assante R, Monaco F, Ferrara F, Arcopinto M, Vriz O, Suzuki T, Cittadini A. Biomarkers in Pulmonary Hypertension. Heart Fail Clin 2018; 14:393-402. [DOI: 10.1016/j.hfc.2018.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sommer N, Richter MJ, Tello K, Grimminger F, Seeger W, Ghofrani HA, Gall H. [Update pulmonary arterial hypertension : Definitions, diagnosis, therapy]. Internist (Berl) 2017; 58:937-957. [PMID: 28819824 DOI: 10.1007/s00108-017-0301-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The term pulmonary arterial hypertension comprises a group of pulmonary vascular diseases of different etiologies that are characterized by similar precapillary vascular remodeling processes and result in exertional dyspnea and right heart insufficiency. The specific pharmacological treatment approach considers the risk of mortality and phenotypical properties and includes treatment with phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostanoids, as well as with more novel substances, such as a soluble guanylyl cyclase stimulator and an oral prostacyclin receptor agonist. The prognosis of the disease is mainly determined by the right heart insufficiency for which there is currently no specific pharmacological treatment. Lung transplantation may be offered as a last option. This review provides an overview of the current European guidelines from 2015 and the recommendations of the Cologne Consensus Conference for pulmonary hypertension from 2016.
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Affiliation(s)
- N Sommer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland.
| | - M J Richter
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - K Tello
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - F Grimminger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
| | - W Seeger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
- Max-Planck-Institut für Herz- und Lungenforschung, Bad Nauheim, Deutschland
| | - H A Ghofrani
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
- Kerckhoff-Klinik, Bad Nauheim, Deutschland
- Department of Medicine, Imperial College London, London, Großbritannien
| | - H Gall
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Deutsches Zentrum für Lungenforschung (DZL), Excellence Cluster Cardiopulmonary System (ECCPS), Klinikstr. 33, 35392, Gießen, Deutschland
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