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Echocardiography fluid assessment

Sebastien Preau, Perrine Bortolotti, Delphine Colling, Florent Dewavrin, Vincent Colas, Benoit Voisin, Thierry Onimus, Elodie Drumez, Alain Durocher, Alban Redheuil, Fabienne Saulnier
OBJECTIVE: To investigate whether the collapsibility index of the inferior vena cava recorded during a deep standardized inspiration predicts fluid responsiveness in nonintubated patients. DESIGN: Prospective, nonrandomized study. SETTING: ICUs at a general and a university hospital. PATIENTS: Nonintubated patients without mechanical ventilation (n = 90) presenting with sepsis-induced acute circulatory failure and considered for volume expansion...
September 30, 2016: Critical Care Medicine
Dorota Sikorska, Krzysztof Pawlaczyk, Anna Olewicz-Gawlik, Natasza Czepulis, Bartlomiej Posnik, Ewa Baum, Maria Wanic-Kossowska, Bengt Lindholm, Andrzej Oko
BACKGROUND: Peritoneal dialysis (PD) patients with preserved residual diuresis have a lower risk of death and complications. Here we analyzed associations between residual diuresis and presence of fluid overload and biomarkers of cardiac strain and nutrition in PD patients. METHODS: Among 44 PD patients placed into three subgroups, depending on volume of residual diuresis (group A ≤ 500; group B 600-1900; and group C ≥ 2000 mL/day), we examined: overhydration (OH) assessed by bioimpedance analysis (BIA; yielding OH index OHBIA) and by clinical criteria (edema and hypertension); nutritional status (by subjective global assessment, SGA); metabolic status (electrolytes, serum lipid profile, CRP, and albumin); biomarkers of fluid overload and cardiac strain (N-terminal probrain natriuretic peptide, NT-proBNP, and troponin T, TnT); and, echocardiography and chest X-ray...
October 12, 2016: International Urology and Nephrology
J Ambrozic, K Prokselj, M Lucovnik
INTRODUCTION: The ability to judge intravascular volume is fundamental in the management of patients with severe preeclampsia. Insufficient intravascular volume can result in decreased oxygen delivery to tissues and exacerbates organ dysfunction. On the other hand, fluid excesses can lead to fluid extravasation and pulmonary edema. Outside of pregnancy, transthoracic echocardiography and lung ultrasonography have become important diagnostic and monitoring tools in critically ill patients...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Philippe Vignon, Xavier Repessé, Emmanuelle Bégot, Julie Léger, Christophe Jacob, Koceila Bouferrache, Michel Slama, Gwenaël Prat, Antoine Vieillard-Baron
RATIONALE: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters which have not yet been compared in large cohorts. OBJECTIVES: To determine the diagnostic accuracy of dynamic parameters used to predict fluid responsiveness in ventilated patients with a circulatory failure of any cause. METHODS: In this multicenter prospective study, respiratory variations of superior vena cava diameter (∆SVC) measured using transesophageal echocardiography, of inferior vena cava diameter (∆IVC) measured using transthoracic echocardiography, of the maximal Doppler velocity in left ventricular outflow tract (∆VmaxAo) measured using either approach, and pulse pressure variations (∆PP) were recorded with the patient in the semi-recumbent position...
September 21, 2016: American Journal of Respiratory and Critical Care Medicine
Paolo Zamboni, Erica Menegatti, Corrado Cittanti, Francesco Sisini, Sergio Gianesini, Fabrizio Salvi, Francesco Mascoli
OBJECTIVE: Increased ventricle volume and brain hypoperfusion are linked to neurodegeneration. We hypothesized that in patients with restricted jugular flow, surgical restoration may reduce brain ventricle volume, because it should improve the pressure gradient, hence promoting cerebrospinal fluid reabsorption into the venous system. METHODS: The effects of restoring the jugular flow were assessed by means of a validated echocardiography with color Doppler (ECD) protocol of flow quantification, magnetic resonance venography, and single-photon emission computed tomography combined with computed tomography (SPECT-CT)...
October 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
María Cristina Di Gioia, Raul Gascuena, Paloma Gallar, Gabriela Cobo, Rosa Camacho, Nuria Acosta, Zsofia Baranyi, Isabel Rodriguez, Aniana Oliet, Olimpia Ortega, Inmaculada Fernandez, Carmen Mon, Milagros Ortiz, Mari C Manzano, Juan C Herrero, José I Martinez, Joaquín Palma, Ana Vigil
BACKGROUND: Chronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. METHODS: Cross-sectional observational study including 76 stable patients...
August 26, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Muzamil Olamide Hassan, Raquel Duarte, Therese Dix-Peek, Ahmed Vachiat, Sagren Naidoo, Caroline Dickens, Sacha Grinter, Pravin Manga, Saraladevi Naicker
BACKGROUND: Fluid overload is common in chronic kidney disease (CKD) patients, potentially driving chronic inflammation and left ventricular dysfunction. We investigated the association between volume overload, chronic inflammation, and left ventricular dysfunction across subgroups of CKD patients. METHODS: The study included 160 participants, comprising peritoneal dialysis (PD), hemodialysis (HD), stage-3 CKD patients, and age- and sex-matched controls (40 in each group)...
August 10, 2016: Clinical Nephrology
John H Boyd, Demetrios Sirounis
PURPOSE OF REVIEW: It has recently become evident that administration of intravenous fluids following initial resuscitation has a greater probability of producing tissue edema and hypoxemia than of increasing oxygen delivery. Therefore, it is essential to have a rational approach to assess the adequacy of volume resuscitation. Here we review passive leg raising (PLR) and respiratory variation in hemodynamics to assess fluid responsiveness. RECENT FINDINGS: The use of ultrasound enhances the clinician's ability to detect and predict fluid responsiveness, whereas enthusiasm for this modality must be tempered by recent evidence that it is only reliable in apneic patients...
October 2016: Current Opinion in Critical Care
Mazin Fatani, Kevin Lachapelle, Farhan Bhanji, Peter McLeod
BACKGROUND: In assessing an unstable patient post cardiac surgery, echocardiography can be an essential tool as part of this assessment. However, it may be under-utilized for several reasons. We conducted this study to  determine the perceived needs and training objectives for echocardiography training for cardiac surgery residents. METHODS: This study was a cross-sectional, stratified national survey of cardiac surgery residents, cardiac surgeons, cardiac surgery program directors and cardiologists, designed to acquire opinions on what type and level of objective-based training in echocardiography is required for cardiac surgery residents...
2016: Journal of Cardiothoracic Surgery
Dorota Sikorska, Krzysztof Pawlaczyk, Magdalena Roszak, Natasza Czepulis, Andrzej Oko, Marek Karczewski, Andrzej Breborowicz, Janusz Witowski
INTRODUCTION: Systemic inflammation, as defined by elevated blood IL-6, is a strong independent predictor of peritoneal dialysis (PD) patient survival. The present study has aimed to determine whether there exists a particular "phenotype" associated with high systemic IL-6 that characterizes PD patients in terms of their fluid status and cardiac parameters. METHODS: Fifty-seven prevalent PD patients were classified according to serum concentrations of IL-6. The degree of overhydration was assessed by bioimpedance analysis (BIA)...
September 2016: Cytokine
Jaeseong Jang, Chi Young Ahn, Jung-Il Choi, Jin Keun Seo
For the assessment of the left ventricle (LV), echocardiography has been widely used to visualize and quantify geometrical variations of LV. However, echocardiographic image itself is not sufficient to describe a swirling pattern which is a characteristic blood flow pattern inside LV without any treatment on the image. We propose a mathematical framework based on an inverse problem for three-dimensional (3D) LV blood flow reconstruction. The reconstruction model combines the incompressible Navier-Stokes equations with one-direction velocity component of the synthetic flow data (or color Doppler data) from the forward simulation (or measurement)...
2016: Computational and Mathematical Methods in Medicine
Olivia Haun de Oliveira, Flávio Geraldo Rezende de Freitas, Renata Teixeira Ladeira, Claudio Henrique Fischer, Antônio Tonete Bafi, Luciano Cesar Pontes Azevedo, Flávia Ribeiro Machado
PURPOSE: The objective of our study was to assess the reliability of the distensibility index of the inferior vena cava (dIVC) as a predictor of fluid responsiveness in postoperative, mechanically ventilated patients and compare its accuracy with that of the pulse pressure variation (PPV) measurement. MATERIALS AND METHODS: We included postoperative mechanically ventilated and sedated patients who underwent volume expansion with 500mL of crystalloids over 15minutes...
August 2016: Journal of Critical Care
Muzamil Olamide Hassan, Raquel Duarte, Therese Dix-Peek, Ahmed Vachiat, Caroline Dickens, Sacha Grinter, Sagren Naidoo, Pravin Manga, Saraladevi Naicker
BACKGROUND: Fluid retention occurs early in chronic kidney disease (CKD) resulting in increased cardiovascular morbidity and mortality. This study aimed to assess volume and nutritional status among South African CKD participants and determine the relationship between malnutrition, inflammation, atherosclerosis, and volume overload using a body composition monitor (BCM). We also evaluated the usefulness of BCM measurement in assessing volume overload. METHODS: 160 participants comprising hemodialysis, peritoneal dialysis, stage 3 CKD patients, and healthy controls (40 in each group) were studied...
July 2016: Clinical Nephrology
Marco Allinovi, Moin A Saleem, Owen Burgess, Catherine Armstrong, Wesley Hayes
BACKGROUND: Lung ultrasound is a novel technique for detecting generalized fluid overload in children and adults with end-stage renal disease (ESRD). Echocardiography and bioimpedance spectroscopy are established methods, albeit variably adopted in clinical practice. We compared the practicality and accuracy of lung ultrasound with current objective techniques for detecting fluid overload in children with ESRD. METHODS: A prospective observational study was performed to compare lung ultrasound B-lines, echocardiographic measurement of inferior vena cava parameters and bioimpedance spectroscopy in the assessment of fluid overload in children with ESRD on dialysis...
June 10, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Massimiliano Meineri
Transesophageal echocardiography (TEE) is a very powerful intraoperative monitoring tool. It allows precise assessment of cardiac anatomy together with dynamic quantification of myocardial performance and flows through the heart chambers. With a high safety profile TEE counts few absolute contraindications. Performance of TEE requires dedicated training. Certification pathways are offered in Europe and North America. Focused, basic and advanced scanning protocols have been lately described for intraoperative and emergent use...
August 2016: Minerva Anestesiologica
Dorota Sobczyk, Krzysztof Nycz, Pawel Andruszkiewicz, Karol Wierzbicki, Maciej Stapor
BACKGROUND: Appropriate fluid management is one of the most important elements of early goal-directed therapy after cardiothoracic surgery. Reliable determination of fluid responsivenss remains the fundamental issue in volume therapy. The purpose of the study was to assess the usefulness of dynamic IVC-derived parameters (collapsibility index, distensibility index) in comparison to passive leg raising, in postoperative fluid management in mechanically ventilated patients with left ventricular ejection fraction ≥ 30 %, immediately after elective coronary artery bypass grafting...
2016: Cardiovascular Ultrasound
Ashley Miller, Justin Mandeville
Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately...
June 2016: Echo Research and Practice
Juhani Rossinen
FATE (Focus Assessed Transthoracic Echocardiography) echocardiography can be learned more quickly than extensive cardiologic examination. It is intended to be used in emergency situations as a qualitative examination to resolve the cardiogenic mechanism of circulatory insufficiency and possible hypovolemia. The procedure is worth utilizing as a dynamic method in the assessment of the response to fluid therapy and vasoactive medications. In many cases, however, a more profound ultrasound imaging will provide essential further information...
2016: Duodecim; Lääketieteellinen Aikakauskirja
Laurent Guérin, Antoine Vieillard-Baron
Echocardiography is a noninvasive and accurate tool used in the intensive care unit to assess cardiac function and monitor hemodynamics in shocked patients. During severe sepsis or septic shock, several mechanisms can lead to hemodynamic failure and have to be quickly and precisely diagnosed to propose adequate, personalized, and timely hemodynamic therapy. Echocardiography truly provides intensivists with this diagnostic possibility, whether or not there is fluid responsiveness, cardiac dysfunction, or persistent vasoplegia...
June 2016: Clinics in Chest Medicine
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