Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients.

Rationale: Assessment of fluid responsiveness relies on dynamic echocardiographic parameters that 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 semirecumbent position.

Initial resuscitation guided by the Surviving Sepsis Campaign recommendations and early echocardiographic assessment of hemodynamics in intensive care unit septic patients: a pilot study.

Objective: To compare therapeutic interventions during initial resuscitation derived from echocardiographic assessment of hemodynamics and from the Surviving Sepsis Campaign guidelines in intensive care unit septic patients.

Design And Setting: Prospective, descriptive study in two intensive care units of teaching hospitals.

Methods: The number of ventilated patients with septic shock who were studied was 46.

Organ failure in the ICU: cardiac alterations.

Cardiac alterations may be defined as changes that lead to abnormal cardiac function. They include decrease in preload, increase in afterload, and depressed cardiac contractility. Cardiac dysfunction differs from cardiac failure: cardiac performance is altered, but this does not necessarily mean that the cardiovascular system is failing.

PaCO2 and alveolar dead space are more relevant than PaO2/FiO2 ratio in monitoring the respiratory response to prone position in ARDS patients: a physiological study.

Introduction: Our aims in this study were to report changes in the ratio of alveolar dead space to tidal volume (VDalv/VT) in the prone position (PP) and to test whether changes in partial pressure of arterial CO2 (PaCO2) may be more relevant than changes in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) in defining the respiratory response to PP. We also aimed to validate a recently proposed method of estimation of the physiological dead space (VDphysiol/VT) without measurement of expired CO2.

Methods: Thirteen patients with a PaO2/FiO2 ratio < 100 mmHg were included in the study.

Cardiac tamponade.

Purpose Of Review: To re-emphasize the epidemiology, pathophysiology, diagnosis, and treatment of cardiac tamponade.

Recent Findings: Cardiac tamponade is a cause of obstructive shock. Incidence of cardiac tamponade is poorly documented.

Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation.

Introduction: Since 2003, we have routinely used percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) to treat patients < 80 years of age after out-of-hospital cardiac arrest (OHCA) related to ventricular fibrillation. The aim of our study was to evaluate the prognostic impact of routine PCI in association with MTH and the potential influence of age.

Methods: We studied 111 consecutive patients resuscitated successfully following OHCA related to shock-sensitive rhythm.

Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis.

Purpose: Since 1997, we have routinely used prone positioning (PP) in patients who have a PaO(2)/FiO(2) below 100 mmHg after 24-48 h of mechanical ventilation and who are ventilated using a low stretch ventilation strategy. We report here the characteristics and prognosis of this subgroup of patients with severe lung injury to illustrate the feasibility, role, and impact of routine PP in acute respiratory distress syndrome (ARDS).

Results: A total of 218 patients were admitted because of ARDS between 1997 and 2009.

Acute respiratory distress syndrome, mechanical ventilation, and right ventricular function.

Purpose Of Review: To reiterate the effects of positive pressure ventilation on right ventricular (RV) function in acute respiratory distress syndrome (ARDS), to explain in which conditions acute cor pulmonale (ACP) may worsen prognosis, and to define an approach to protection of the right ventricle.

Recent Findings: In unselected populations of ARDS patients, large studies have reported a 25% incidence of ACP. ACP has deleterious consequences, such as patent foramen ovale shunting and fewer ventilator-free days within the first 28 days.