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https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#1
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27903511/cardiac-remodeling-and-increased-central-venous-pressure-underlie-elevated-stroke-volume-and-cardiac-output-of-seawater-acclimated-rainbow-trout
#2
Jeroen Brijs, Erik Sandblom, Esmée Dekens, Joacim Näslund, Andreas Ekström, Michael Axelsson
Substantial increases in cardiac output (CO), stroke volume (SV) and gastrointestinal blood flow are essential for euryhaline rainbow trout (Oncorhyncus mykiss) osmoregulating in seawater. However, the underlying hemodynamic mechanisms responsible for these changes are unknown. By examining a range of circulatory and cardiac morphological variables of seawater- and freshwater-acclimated rainbow trout, the present study revealed a significantly higher central venous pressure (CVP) in seawater-acclimated trout (~0...
November 30, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
https://www.readbyqxmd.com/read/27878445/can-non-invasive-ventilation-modify-central-venous-pressure-comparison-between-invasive-measurement-and-ultrasonographic-evaluation
#3
Maurizio Zanobetti, Alessio Prota, Alessandro Coppa, Laura Giordano, Sofia Bigiarini, Peiman Nazerian, Francesca Innocenti, Alberto Conti, Federica Trausi, Simone Vanni, Giuseppe Pepe, Riccardo Pini
Central venous pressure (CVP) is primarily measured to assess intravascular volume status and heart preload. In clinical practice, the measuring device most commonly used in emergency departments and intensive care units, is an electronic transducer that interconnects a central venous catheter (CVC) with a monitoring system. Non-invasive ventilation (NIV) consists in a breathing support that supplies a positive pressure in airways through a mask or a cask though not using an endotracheal prosthesis. In emergency settings, non-invasive ultrasonography evaluation of CVP, and hence of intravascular volume status entail the measurement by a subxiphoid approach of inferior vena cava diameter and its variations in relation to respiratory activity...
November 22, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27872408/active-expiration-and-the-measurement-of-central-venous-pressure
#4
Sheldon Magder, Karim Serri, Sara Verscheure, Renée Chauvin, Peter Goldberg
PURPOSE: To obtain a point prevalence estimate of alterations in central venous pressure (CVP) produced by active expiration in a consecutive series of intensive care patients. METHODS: We evaluated CVP tracings taken by the nurses at their morning shift change in a consecutive series of 60 cardiac surgery and 59 noncardiac surgery patients. We also assessed change in values due to the change in transducer level. Three physicians and a nurse instructor independently reviewed the tracings and determined whether there was evidence of forced expiration and whether it was type A, defined by decreasing CVP during expiration, or type B, defined by increasing CVP during expiration...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27819002/diagnosis-accuracy-of-mean-arterial-pressure-variation-during-a-lung-recruitment-maneuver-to-predict-fluid-responsiveness-in-thoracic-surgery-with-one-lung-ventilation
#5
Woon-Seok Kang, Chung-Sik Oh, Chulmin Park, Bo Mi Shin, Tae-Gyoon Yoon, Ka-Young Rhee, Nam-Sik Woo, Seong-Hyop Kim
: Background. Lung recruitment maneuver (LRM) during thoracic surgery can reduce systemic venous return and resulting drop in systemic blood pressure depends on the patient's fluid status. We hypothesized that changes in systemic blood pressure during the transition in LRM from one-lung ventilation (OLV) to two-lung ventilation (TLV) may provide an index to predict fluid responsiveness. Methods. Hemodynamic parameters were measured before LRM (T0); after LRM at the time of the lowest mean arterial blood pressure (MAP) (T1) and at 3 minutes (T2); before fluid administration (T3); and 5 minutes after ending it (T4)...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27815151/right-atrial-pressure-in-the-critically-ill-how-to-measure-what-is-the-value-what-are-the-limitations
#6
REVIEW
Sheldon Magder
Right atrial pressure (Pra) is determined by the interaction of the function of the heart as a pump, called cardiac function, and the factors that determine the return of blood to heart, called return function. Thus, monitoring Pra or its surrogate, central venous pressure (CVP), can give important insights into mechanisms behind changes in hemodynamic status, responses to interventions, and the likelihood of diagnoses. Examination of the components of the Pra tracing, especially during the ventilator cycle, also can give information about right heart diastolic function, status of the tricuspid valve, volume responsiveness and the cardiac rhythm...
November 1, 2016: Chest
https://www.readbyqxmd.com/read/27788791/intraoperative-pleth-variability-index-is-linked-to-delayed-graft-function-after-kidney-transplantation
#7
O Collange, L Jazaerli, A Lejay, C Biermann, S Caillard, B Moulin, N Chakfe, F Severac, M Schaeffer, P-M Mertes, A Steib
BACKGROUND: Delayed graft function (DGF) is an early postoperative complication of kidney transplantation (KT) predisposing to acute rejection and lower graft survival. Intraoperative arterial hypotension and hypovolemia are associated with DGF. Central venous pressure (CVP) is used to estimate volemia but its reliability has been criticized. Pleth variability index (PVI) is a hemodynamic parameter predicting fluid responsiveness. The aim of this study was to examine the relationship between intraoperative PVI and CVP values and the occurrence of DGF...
October 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27777780/initial-central-venous-pressure-could-be-a-prognostic-marker-for-hemodynamic-improvement-of-polymyxin-b-direct-hemoperfusion-a-retrospective-cohort-study
#8
Hiroyuki Yamada, Tatsuo Tsukamoto, Hiromichi Narumiya, Kazumasa Oda, Satoshi Higaki, Ryoji Iizuka, Motoko Yanagita, Masako Deguchi
BACKGROUND: Direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) could improve the hemodynamic status of septic shock patients. As PMX-DHP is an invasive and costly procedure, it is desirable to estimate the therapeutic effect before performing the therapy. However, it is still unclear when this therapy should be started and what type of sepsis it should be employed for. In this study, we retrospectively examined the clinical effect of patients treated with PMX-DHP by using central venous pressure (CVP)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27773456/clinical-hemodynamic-evaluation-of-patients-implanted-with-a-fully-magnetically-levitated-left-ventricular-assist-device-heartmate-3
#9
Nir Uriel, Sirtaz Adatya, Jiří Malý, Eric Kruse, Daniel Rodgers, Gerald Heatley, Aleš Herman, Poornima Sood, Dominik Berliner, Johann Bauersachs, Axel Haverich, Michael Želízko, Jan D Schmitto, Ivan Netuka
BACKGROUND: The HeartMate 3 (HM3) is a Conformiteé Européenne (CE) mark-approved left ventricular assist device (LVAD) with a fully magnetically levitated rotor with features consisting of a wide range of operational speeds, wide flow paths and an artificial pulse. We performed a hemodynamic and echocardiographic evaluation of patients implanted with the HM3 LVAD to assess the speed range for optimal hemodynamic support. METHODS: Sixteen HM3 patients underwent pump speed ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP] and blood pressure [BP]) and 3-dimensional echocardiography (3DE)...
July 17, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27762259/inferior-vena-cava-collapsibility-index-is-a-valuable-and-non-invasive-index-for-elevated-general-heart-end-diastolic-volume-index-estimation-in-septic-shock-patients
#10
Jie Zhao, Guolin Wang
BACKGROUND This study aimed to investigate the relationship between the inferior vena cava respirophasic variation (IVC collapsibility index [IVCCI]) and the general heart end-diastolic volume index (GEDVI). By determining the above relationship, we could evaluate the utility of IVCCI as an indicator. MATERIAL AND METHODS Forty-two septic patients were finally enrolled in this study. The inferior vena cava's diameter was measured with the largest at the end of expiration (IVC3) and with the smallest at the end of inspiration (IVCi) on the ultrasound (IVCCI=[(IVCD e - IVCD i)/IVCD e] ×100%)...
October 20, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27737348/noradrenaline-and-dobutamine-effects-on-the-volume-expansion-with-normal-saline-in-rabbits-subjected-to-hemorrhage
#11
Gualter Lisboa Ramalho, Matheus Fachini Vane, Luciana Cavalcanti Lima, Lucas Fachini Vane, Rosa Beatriz Amorim, Maria Aparecida Domingues, José Mariano Soares de Moraes, Lídia Raquel de Carvalho, Pedro Paulo Tanaka, Luiz Antonio Vane
PURPOSE: To evaluate the effects of dobutamine (DB), noradrenaline (NA), and their combination (NADB), on volume retention in rabbits submitted to hemorrhage. METHODS: Thirty six rabbits were randomly divided into 6 groups: SHAM, Control, Saline, DB, NA, DB+NA. All the animals, except for SHAM, were subjected to hemorrhage of 25% of the calculated blood volume. Control animals were replaced with their own blood. The other groups received NSS 3 times the volume withdrawn...
September 2016: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/27716694/perioperative-utility-of-goal-directed-therapy-in-high-risk-cardiac-patients-undergoing-coronary-artery-bypass-grafting-a-clinical-outcome-and-biomarker-based-study
#12
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Rawat, Yatin Mehta
Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass...
October 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27686439/-the-correlation-between-optic-nerve-sheath-diameter-and-volume-status-in-patients-after-cardiac-surgery
#13
H Chen, X T Wang, X Ding, H M Zhang, H Zhao, Y G Chao, W He, D W Liu
Objective: To investigate the relationship between optic nerve sheath diameter (ONSD) and volume status of patients after cardiac surgery. Methods: A total of consecutive 56 patients who were treated in Critical Care Unit in Peking Union Medical College Hospital after open heart surgery from January to August 2015 were screened in this study. Central venous pressure (CVP) and 72 h net fluid balance were monitored. ONSD and diameter of inferior vena cava (IVC) were measured by ultrasound. Results: A total of 44 patients were finally included in the study...
October 1, 2016: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/27673307/will-this-hemodynamically-unstable-patient-respond-to-a-bolus-of-intravenous-fluids
#14
Peter Bentzer, Donald E Griesdale, John Boyd, Kelly MacLean, Demetrios Sirounis, Najib T Ayas
IMPORTANCE: Fluid overload occurring as a consequence of overly aggressive fluid resuscitation may adversely affect outcome in hemodynamically unstable critically ill patients. Therefore, following the initial fluid resuscitation, it is important to identify which patients will benefit from further fluid administration. OBJECTIVE: To identify predictors of fluid responsiveness in hemodynamically unstable patients with signs of inadequate organ perfusion. DATA SOURCES AND STUDY SELECTION: Search of MEDLINE and EMBASE (1966 to June 2016) and reference lists from retrieved articles, previous reviews, and physical examination textbooks for studies that evaluated the diagnostic accuracy of tests to predict fluid responsiveness in hemodynamically unstable adult patients who were defined as having refractory hypotension, signs of organ hypoperfusion, or both...
September 27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27668696/corrective-effect-of-norepinephrine-on-hypotension-induced-by-dexmedetomidine-in-critically-ill-patients
#15
Donghao Wang, Yongmei Cao, Yi Lyu, Yingchuan Li, Tao Han
PURPOSE: To evaluate the corrective effect of norepinephrine on hypotension induced by dexmedetomidine through monitoring sedation status, hemodynamics as well as oxygen metabolism. METHODS: 100 patients administered standard-dose dexmedetomidine therapy with RASS between -2 and 0 in the intensive care unit (ICU) were included in the study. According to the application of norepinephrine to correct hypotension after dexmedetomidine therapy, the patients were divided into two groups: group A and group B...
December 2016: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27648024/a-non-invasive-method-for-assessment-of-intravascular-fluid-status-inferior-vena-cava-diameters-and-collapsibility-index
#16
Sinan Karacabey, Erkman Sanri, Ozlem Guneysel
OBJECTIVE: To evaluate the correlation between central venous pressure (CVP) and inferior vena cava (IVC) diameters measured by ultrasonography (Ultrasound) in critically ill patients. METHODS: Intubated critically ill patients were enrolled. The CVP values were measured using a U-tube manometer and were compared to the IVC diameters and collapsibility index, which were measured by bedside Ultrasound. Patients younger than 18 years old, who were not intubated, who had an abdominal pressure greater than 12 mmHg, and/or who were admitted for trauma were excluded from the study...
July 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/27636673/measurement-of-pleural-pressure-swings-with-a-fluid-filled-esophageal-catheter-vs-pulmonary-artery-occlusion-pressure
#17
S Verscheure, P B Massion, S Gottfried, P Goldberg, L Samy, P Damas, S Magder
PURPOSE: Pleural pressure measured with esophageal balloon catheters (Peso) can guide ventilator management and help with the interpretation of hemodynamic measurements, but these catheters are not readily available or easy to use. We tested the utility of an inexpensive, fluid-filled esophageal catheter (Peso) by comparing respiratory-induced changes in pulmonary artery occlusion (Ppao), central venous (CVP), and Peso pressures. METHODS: We studied 30 patients undergoing elective cardiac surgery who had pulmonary artery and esophageal catheters in place...
August 31, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27624218/ventilator-induced-central-venous-pressure-variation-can-predict-fluid-responsiveness-in-post-operative-cardiac-surgery-patients
#18
T G V Cherpanath, B F Geerts, J J Maas, R B P de Wilde, A B Groeneveld, J R Jansen
BACKGROUND: Ventilator-induced dynamic hemodynamic parameters such as stroke volume variation (SVV) and pulse pressure variation (PPV) have been shown to predict fluid responsiveness in contrast to static hemodynamic parameters such as central venous pressure (CVP). We hypothesized that the ventilator-induced central venous pressure variation (CVPV) could predict fluid responsiveness. METHODS: Twenty-two elective cardiac surgery patients were studied post-operatively on the intensive care unit during mechanical ventilation with tidal volumes of 6-8 ml/kg without spontaneous breathing efforts or cardiac arrhythmia...
November 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27606159/pleth-variability-index-and-respiratory-system-compliance-to-direct-peep-settings-in-mechanically-ventilated-patients-an-exploratory-study
#19
Jing Zhou, Yi Han
OBJECTIVES: To analyze the ability of pleth variability index (PVI) and respiratory system compliance (RSC) on evaluating the hemodynamic and respiratory effects of positive end expiratory pressure (PEEP), then to direct PEEP settings in mechanically ventilated critical patients. METHODS: We studied 22 mechanically ventilated critical patients in the intensive care unit. Patients were monitored with classical monitor and a pulse co-oximeter, with pulse sensors attached to patients' index fingers...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27597811/assessment-of-postresuscitation-volume-status-by-bioimpedance-analysis-in-patients-with-sepsis-in-the-intensive-care-unit-a-pilot-observational-study
#20
Bram Rochwerg, Jason H Cheung, Christine M Ribic, Faraz Lalji, France J Clarke, Susheel Gantareddy, Nischal Ranganath, Aziz Walele, Ellen McDonald, Maureen O Meade, Deborah J Cook, Trevor T Wilkieson, Catherine M Clase, Peter J Margetts, Azim S Gangji
Background. Bioimpedance analysis (BIA) is a novel method of assessing a patient's volume status. Objective. We sought to determine the feasibility of using vector length (VL), derived from bioimpedance analysis (BIA), in the assessment of postresuscitation volume status in intensive care unit (ICU) patients with sepsis. Method. This was a prospective observational single-center study. Our primary outcome was feasibility. Secondary clinical outcomes included ventilator status and acute kidney injury. Proof of concept was sought by correlating baseline VL measurements with other known measures of volume status...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
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