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Robin, Emmanuel; Costecalde, M.; Lebuffe, Gilles; Vallet, B.

doi:10.1186/cc4830

Cited by 56 publications

(10 citation statements)

References 54 publications

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“…18,19 In this study, we tested the concept that an early goal-directed therapy, based on pre-defined hemodynamic criteria with a pulmonary artery catheter could improve renal function in heart failure patients with LCOS. However, both treatment strategies, namely goal directed and conventional, were associated with improvements in renal function and hemodynamic parameters.…”

Section: ■ Discussionmentioning

confidence: 99%

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Bastos¹,

Ferri²,

Lima³

et al. 2016

Medical Express

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OBJECTIVES:Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach. METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate. RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups. CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.

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Section: ■ Discussionmentioning

confidence: 99%

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Bastos¹,

Ferri²,

Lima³

et al. 2016

Medical Express

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“…Available monitoring parameters to guide hemodynamic management consist of measurements of pressures (systemic and pulmonary artery pressures, central venous pressure) and flow (cardiac output measurements). However, cardiac filling pressure data have known limitations and might not accurately represent cardiac preload and contractility [ 1 ]. To date, continuous or sequential recording of cardiac output parameters is limited to pulse contour analysis and indicator-dilution techniques [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of hemodynamic monitoring using a single-use transesophageal echocardiography probe in critically ill patients – study protocol for a randomized controlled trial

Cioccari

Zante

Bloch

et al. 2018

Trials

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BackgroundHemodynamic instability is one of the leading causes of intensive care unit (ICU) admission. Early stabilization of hemodynamics is associated with improved outcome. The monitoring used to guide hemodynamic support may influence the time needed to achieve stable hemodynamics. Visualization of the heart using echocardiography offers the advantage of direct measurement of cardiac volumes and ventricular function. A miniaturized monoplane transesophageal echocardiography (TEE) probe was developed, allowing for almost continuous qualitative hemodynamic TEE assessment (hTEE) after brief bedside training. The primary objective of the study is to assess whether hemodynamic monitoring using the hTEE technology shortens time to resolution of shock in ICU patients in comparison to standard monitoring using a central venous catheter, pulmonary artery catheter, or conventional echocardiography.MethodsFive hundred consecutive subjects with circulatory shock (low mean arterial blood pressure (MAP) and signs of organ hypoperfusion) at the time of ICU admission are included in the study. The subjects are randomly assigned to one of four groups using a 2 × 2 factorial design stratified by method of hemodynamic monitoring (hTEE vs standard hemodynamic monitoring) and frequency of hemodynamic assessments (minimum every 4 h vs standard of care). The primary study outcome is the time from study inclusion to resolution of circulatory shock, defined as MAP > 60 mmHg for ≥ 4 h after discontinuation of vasopressors and inotropes. The hTEE monitoring consists of the acquisition of three defined echocardiography views: Transgastric mid-esophageal short axis with measurement of fractional area change of left ventricle, mid-esophageal four-chamber view with measurement of the ratio of right to left ventricular area, and mid-esophageal ascending aortic short-axis view with measurement of the superior vena cava collapsibility index. In the control groups, monitoring modalities, including conventional TTE and TEE but not hTEE, are at the discretion of the treating physician. The interpretation of hemodynamic monitoring and the subsequent changes in patient management are recorded after each hemodynamic assessment. Differences in the primary and further secondary time-to-event outcomes will be assessed using a competing risk model accounting for the competing risk of death.DiscussionThe effect of using echocardiography as a monitoring modality on relevant patient outcomes has not been established so far. The study at hand may be one of the first trials to provide detailed data on effectiveness and safety of echocardiography to guide treatment in patients with circulatory shock.Trial registrationClinicalTrials.gov, ID: NCT02048566. Registered on January 29, 2014. Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2714-4) contains supplementary material, which is available to authorized users.

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“…Moreover, at least three measurements are recommended for real-time intermittent thermodilution method using PAC, with its inherent problems regarding operator dependency and drift causing a discrepancy of up to 15%. 24 25 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery

Lee

Chang

et al. 2015

Yonsei Med J

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PurposeWe compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery.Materials and MethodsFifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index ≥2 L/min/m2: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints.ResultsPatient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2±4.8 days vs. 10.8±4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652±519 mL vs. 11430±463 mL, p=0.004).ConclusionNICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization.

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Untitled

Cited by 56 publications

References 54 publications

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Effects of hemodynamic monitoring using a single-use transesophageal echocardiography probe in critically ill patients – study protocol for a randomized controlled trial

Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery

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