Aortic dP/dtmax accurately reflects left ventricular contractility when effective preload independence is achieved

peer reviewe

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

Background: Peak first derivative of femoral artery pressure (arterial dP/dt max) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dt maxis reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dt maxwas compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r = 0.51; p < 0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV) ≤ 11% (r = 0.77; p < 0.001).Conclusion: While arterial dP/dt maxand Ees were significantly correlated during various hemodynamic conditions, arterial dP/dt maxwas more accurate for assessing LV contractility when adequate vascular filling, defined as PPV ≤ 11%, was achieved. © 2012 Morimont et al; licensee BioMed Central Ltd

Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): A Prospective Longitudinal Observational Study

BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20 000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management

Determination of cardiac performance in healthy dogs during maximal inotropic stimulation with dobutamine

info:eu-repo/semantics/nonPublishe

L'algorithme ALERT. Pourquoi, qui, comment, quand?

peer reviewedLa réanimation guidée par téléphone consiste à guider le témoin d'un arrêt cardiaque, formé ou non à la réanimation cardio-pulmonaire, en lui donnant des consignes standardisées par téléphone. Ces instructions lui permettent de vérifier l'état de conscience de la victime, de dégager ses voies aériennes, d'apprécier la présence d'une respiration efficace et de mettre en train des compressions thoraciques en cas d'état de mort apparente. L'Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone (ALERT) est un protocole original permettant aux dispatchers 112 de notre pays d'encadrer l'appelant durant la fenêtre de temps qui débute avec l'appel à l'aide pour se terminer à l'arrivée des équipes de secours spécialisés sur place. Son emploi est associé à un accroissement significatif de la fréquence et de la qualité des gestes de réanimation mis en train par le témoin permettant d'accroître les chances de survie de la victime d'un arrêt cardio-respiratoire extra-hospitalier (ACREH

How I explore a case of suspected arhrhythmogenic right ventricularr dysplasiia

peer reviewedLa dysplasie arythmogène du ventricule droit est une pathologie rare, mais non exceptionnelle, associant la survenue d’arythmies pouvant être mortelles à une détérioration progressive de la structure et de la fonction du ventricule droit. Dans cet article, nous rappelons les bases étiopathogéniques de l’affection et insistons sur la démarche diagnostique