53 research outputs found
Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients.
BackgroundLeft ventricular stroke area by transoesophageal echocardiographic automated border detection has been shown to be strongly correlated to left ventricular stroke volume. Respiratory variations in left ventricular stroke volume or its surrogates are good predictors of fluid responsiveness in mechanically ventilated patients. We hypothesised that respiratory variations in left ventricular stroke area (DeltaSA) can predict fluid responsiveness.MethodsEighteen mechanically ventilated patients undergoing coronary artery bypass grafting were studied immediately after induction of anaesthesia. Stroke area was measured on a beat-to-beat basis using transoesophageal echocardiographic automated border detection. Haemodynamic and echocardiographic data were measured at baseline and after volume expansion induced by a passive leg raising manoeuvre. Responders to passive leg raising manoeuvre were defined as patients presenting a more than 15% increase in cardiac output.ResultsCardiac output increased significantly in response to volume expansion induced by passive leg raising (from 2.16 +/- 0.79 litres per minute to 2.78 +/- 1.08 litres per minute; p < 0.01). DeltaSA decreased significantly in response to volume expansion (from 17% +/- 7% to 8% +/- 6%; p < 0.01). DeltaSA was higher in responders than in non-responders (20% +/- 5% versus 10% +/- 5%; p < 0.01). A cutoff DeltaSA value of 16% allowed fluid responsiveness prediction with a sensitivity of 92% and a specificity of 83%. DeltaSA at baseline was related to the percentage increase in cardiac output in response to volume expansion (r = 0.53, p < 0.01).ConclusionDeltaSA by transoesophageal echocardiographic automated border detection is sensitive to changes in preload, can predict fluid responsiveness, and can quantify the effects of volume expansion on cardiac output. It has potential clinical applications
Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers
IntroductionPleth Variability Index (PVI) is a new algorithm that allows continuous and automatic estimation of respiratory variations in the pulse oximeter waveform amplitude. Our aim was to test its ability to detect changes in preload induced by passive leg raising (PLR) in spontaneously breathing volunteers.MethodsWe conducted a prospective observational study. Twenty-five spontaneously breathing volunteers were enrolled. PVI, heart rate and noninvasive arterial pressure were recorded. Cardiac output was assessed using transthoracic echocardiography. Volunteers were studied in three successive positions: baseline (semirecumbent position); after PLR of 45 degrees with the trunk lowered in the supine position; and back in the semirecubent position.ResultsWe observed significant changes in cardiac output and PVI during changes in body position. In particular, PVI decreased significantly from baseline to PLR (from 21.5 +/- 8.0% to 18.3 +/- 9.4%; P < 0.05) and increased significantly from PLR to the semirecumbent position (from 18.3 +/- 9.4% to 25.4 +/- 10.6 %; P < 0.05). A threshold PVI value above 19% was a weak but significant predictor of response to PLR (sensitivity 82%, specificity 57%, area under the receiver operating characteristic curve 0.734 +/- 0.101).ConclusionPVI can detect haemodynamic changes induced by PLR in spontaneously breathing volunteers. However, we found that PVI was a weak predictor of fluid responsiveness in this setting
Overview of the current use of levosimendan in France: a prospective observational cohort study
Abstract Background Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. Method The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. Results The patients included ( n =â602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock ( n =â250, 41.5%), decompensated heart failure ( n =â127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment ( n =â86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation ( n =â82, 13.6%). They received 0.18â±â0.07 ”g/kg/min levosimendan over 26â±â8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. Conclusions We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied
Perioperative hemodynamic optimization using the photoplethysmography in colorectal surgery (the PANEX3 trial): study protocol for a randomized controlled trial
Control of Postoperative Hypotension Using a Closed-Loop System for Norepinephrine Infusion in Patients After Cardiac Surgery: A Randomized Trial.
Evaluation de la microcirculation par la saturation tissulaire en oxygĂšne en chirurgie cardiaque sous circulation extracorporelle
LYON1-BU Santé (693882101) / SudocSudocFranceF
Evaluation du monitorage de l'hémoglobine par oxymétrie cérébrale en chirurgie cardiaque
Le monitorage continu de l'hĂ©moglobine pourrait avoir un intĂ©rĂȘt en chirurgie cardiaque, afin d'identifier prĂ©cocement les hĂ©morragies et de mieux gĂ©rer les transfusions. L'objectif de l'Ă©tude Ă©tait de savoir si l'hĂ©moglobine tissulaire (Hbt) obtenue par l'oxymĂštre cĂ©rĂ©bral Fore-Sight (CAS Medical Systems, Branford, CT, USA) Ă©tait corrĂ©lĂ©e Ă l'hĂ©moglobine artĂ©rielle (Hba) dĂ©terminĂ©e par un analyseur d'hĂ©mogramme, et si les variations de l'Hbt Ă©taient corrĂ©lĂ©es aux variations de l'Hba lors de la chirurgie cardiaque sous circulation extracorporelle (CEC). Trente patients ont Ă©tĂ© Ă©tudiĂ©s en chirurgie cardiaque sous CEC. Deux capteurs de l'oxymĂštre cĂ©rĂ©bral Ă©taient fixĂ©s sur le front du patient, permettant de recueillir une Hbt toutes les deux secondes, disponible a posteriori aprĂšs tĂ©lĂ©chargement des donnĂ©es. L'Hbt Ă©tait comparĂ©e Ă l'Hba prĂ©levĂ©e sur un cathĂ©ter artĂ©riel radial et dĂ©terminĂ©e par un analyseur d'hĂ©mogramme lors de trois temps de chirurgie cardiaque: Ă la fin de l'induction anesthĂ©sique, dix minutes aprĂšs la cardioplĂ©gie puis Ă la fin de l'intervention chirurgicale. L'Hbt Ă©tait faiblement corrĂ©lĂ©e Ă l'Hba (r = 0,28; P = 0,007). Des valeurs basses d'Hbt ne permettaient pas de prĂ©dire de façon pertinente des valeurs d'Hba infĂ©rieures Ă 10 g/dL (aire sous la courbe = 0,66; P = 0,01). MalgrĂ© un taux de concordance satisfaisant Ă 87 % aprĂšs exclusion des variations d'hĂ©moglobine de moins de 5 % lors de l'analyse des quatre quadrants, les variations de l'Hbt Ă©taient insuffisamment corrĂ©lĂ©es aux variations de l'Hba (R2 = 0,40; P < 0,001). En conclusion, ni les valeurs brutes, ni les variations de l'Hbt ne sont acceptables pour valider l'utilisation de l'oxymĂštre cĂ©rĂ©bral Fore-Sight en chirurgie cardiaque dans la dĂ©tection prĂ©coce des hĂ©morragies et l'aide Ă la dĂ©cision transfusionnelle. L'Hbt pourrait cependant reflĂ©ter l'hĂ©moglobine fonctionnelle circulant dans les tissus traversĂ©s par le faisceau lumineux.LYON1-BU SantĂ© (693882101) / SudocSudocFranceF
IntĂ©rĂȘt des variations respiratoires de l'onde R de l'Ă©lectrocardiogramme pour prĂ©dire la rĂ©ponse au remplissage vasculaire chez le patient ventilĂ©
LYON1-BU Santé (693882101) / SudocSudocFranceF
Evaluation de deux systÚmes peu invasifs de monitorage du débit cardiaque continu en post-opératoire de chirurgie cardiaque ( l'EsCCOD et l'ECOM )
L'ECOM (Endotracheal Cardiac Output Monitor, ConMed) et l'esCCO (EStimated ECG-Sp02 Continous Cardiac Output, Nihon Kohden) sont deux dispositifs de monitorage du dĂ©bit cardiaque (DC) peu invasifs. Ils sont commercialisĂ©s malgrĂ© les incertitudes sur leur capacitĂ© Ă mesurer les variations de DC. Nous les avons donc comparĂ©s Ă la mĂ©thode de rĂ©fĂ©rence, le cathĂ©ter artĂ©riel pulmonaire (CAP) au cours d'une manĆuvre de recrutement alvĂ©olaire (MRA). AprĂšs accord du ComitĂ© Consultatif de Protection des Personnes, les patients en rythme sinusal sans dysfonction ventriculaire ont Ă©tĂ© Ă©tudiĂ©s en ventilation mĂ©canique contrĂŽlĂ©e en postopĂ©ratoire de chirurgie cardiaque. Ils Ă©taient Ă©quipĂ©s d'un CAP, d'un cathĂ©ter artĂ©riel radial et de la sonde endotrachĂ©ale spĂ©cifique de l'ECOM. AprĂšs calibration non invasive, l'EsCCO mesurait le DC par analyse du temps de transit de l'onde de pouls au moyen d'un capteur ECG et d'un oxymĂštre de pouls. L'ECOM, reliĂ© Ă la sonde d'intubation et au cathĂ©ter artĂ©riel, mesurait les changements d'impĂ©dance Ă©lectrique dans l'aorte ascendante. AprĂšs stabilisation et rĂ©chauffement, les mesures hĂ©modynamiques Ă©taient rĂ©alisĂ©es en faisant varier la pression expiratoire positive respectivement de 0, 15 puis retour Ă 0 cmH20 (Tl, T2 et T3). Le DC de rĂ©fĂ©rence Ă©tait obtenu par la moyenne de trois Ă cinq bolus par thermodilution sur le CAP. La comparaison des valeurs de DC et de leurs variations Ă©tait rĂ©alisĂ©e par la mĂ©thode de ElandAltman puis par analyse polaire. L'Ă©tude portait sur 27 patients. Les variations moyennes du DC entre Tl et T2 puis T2 et T3 Ă©taient respectivement de - 30,6% [26,0-35,3] et+ 51,4% [41,9-63,2]. L'analyse de ElandAltman montrait un biais et des limites de concordance de - 0,26+- 3,27 L/min et 0,06 +- 2,94 L/min avec des pourcentages d'erreur de 66% et de 57% pour l'EsCCO et l'ECOM respectivement. L'analyse polaire montrait des biais angulaires et des limites de concordance de - 29 +- 37 et -15+- 30 avec des taux de concordance de 41% et 88% pour l'EsCCO et l'ECOM respectivement. Dans cette Ă©tude, l'EsCCO ne rĂ©pond pas aux critĂšres d'acceptabilitĂ© clinique au cours d'une MRA. En revanche, l'ECOM a une prĂ©cision suffisante pour suivre les variations de DCLYON1-BU SantĂ© (693882101) / SudocSudocFranceF
RÎle du nitroprussiate de sodium sur la microcirculation hépato-splanchnique au cours d'un modÚle porcin de choc septique
LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
- âŠ