Circulatory shock is a common and important diagnosis in the critical care environment. Hemodynamic monitoring is quintessential in the management of shock. The currently used hemodynamic monitoring devices not only measure cardiac output but also provide data related to the prediction of fluid responsiveness, extravascular lung water, and also pulmonary vascular permeability. Additionally, these devices are minimally invasive and associated with fewer complications. The area of hemodynamic monitoring is progressively evolving with a trend toward the use of minimally invasive devices in this area. The critical care physician should be well-versed with current hemodynamic monitoring limitations and stay updated with the upcoming advances in this field so that optimal therapy can be delivered to patients in circulatory shock.
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http://dx.doi.org/10.1055/s-0043-1772175 | DOI Listing |
J Robot Surg
January 2025
Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre, Université Paris Cité, 149, Rue de Sèvres 75015, Paris, France.
Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) is the commonest urologic procedure performed in children, entailing retroperitoneal CO2 insufflation and lateral decubitus, whose effects on cardiopulmonary variables are poorly known. We, therefore, studied hemodynamic and respiratory changes due to CO2 insufflation and lateral decubitus in children undergoing R-RALP and their effects on regional tissue oxygenation. Between 1/2021 and 7/2024, children affected by ureteropelvic joint obstruction (UPJO) underwent a pyeloplasty by R-RALP at Necker Enfants Malades Hospital (Paris, France), using a standardized surgical technique and a lung-protecting anesthetic protocol aimed to prevent hypercarbia.
View Article and Find Full Text PDFPediatr Neurol
December 2024
Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address:
Background: During infant aortic arch reconstruction, traditional electroencephalography (EEG) provides only qualitative data limiting neuromonitoring efficacy. Interhemispheric differences in the alpha:delta ratio (ADR) and suppression ratio (SR) measured using quantitative EEG generate numerical trends that may suggest cerebral ischemia. We hypothesized that the ADR and SR during cardiopulmonary bypass (CPB) would correlate with hemodynamics, and that ADR and SR interhemispheric differences would precede neurological injury from infants requiring aortic arch reconstruction.
View Article and Find Full Text PDFCrit Care
January 2025
División de Terapia Intensiva, Hospital Juan A. Fernández, Buenos Aires, Argentina.
The advancements in cardiovascular imaging over the past two decades have been significant. The miniaturization of ultrasound devices has greatly contributed to their widespread adoption in operating rooms and intensive care units. The integration of AI-enabled tools has further transformed the field by simplifying echocardiographic evaluations and enhancing the reproducibility of hemodynamic measurements, even for less experienced operators.
View Article and Find Full Text PDFJ Nucl Med
January 2025
Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China; and
The purpose of this study was to investigate the feasibility of using F-labeled fibroblast activation protein inhibitor (FAPI) PET/CT in assessing the fibrotic remodeling of the pulmonary artery (PA) and the right ventricle (RV) in pulmonary arterial hypertension (PAH). In a rat model of monocrotaline-induced PAH, rats were euthanized at different time points for tissue analysis (fibroblast activation protein immunofluorescence and Masson's trichrome staining) after completing F-FAPI PET/CT and hemodynamic measurements. Thirty-eight PAH patients were enrolled to participate in F-FAPI PET/CT imaging, with right heart catheterization and echocardiography performed within 1 wk to assess pulmonary hemodynamics and cardiac function.
View Article and Find Full Text PDFJ Intensive Care
January 2025
Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA.
Sepsis often leads to vasoplegia and a hyperdynamic cardiac state, with treatment focused on restoring vascular tone. However, sepsis can also cause reversible myocardial dysfunction, particularly in the elderly with pre-existing heart conditions. The Surviving Sepsis Campaign Guidelines recommend using dobutamine with norepinephrine or epinephrine alone for patients with septic shock with cardiac dysfunction and persistent hypoperfusion despite adequate fluid resuscitation and stable blood pressure.
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