Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis

Géri, Guillaume; Vignon, Philippe; Aubry, Alix; Fedou, Anne-Laure; Charron, Cyril; Silva, Stein; Repessé, Xavier; Vieillard‐Baron, Antoine

doi:10.1007/s00134-019-05596-z

Cited by 153 publications

(135 citation statements)

References 35 publications

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“…Echocardiographic patterns reported by survey respondents were consistent with cardiovascular clusters recently described in septic shock [16] and underscore the value of ultrasound evaluations to identify the underlying mechanisms of shock and select the most appropriate therapy. Only a minority of echocardiographic evaluations were done using a transesophageal approach.…”

Section: Discussionsupporting

confidence: 71%

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

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Purpose To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). Methods A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. Results Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). Conclusion Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.

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Section: Discussionsupporting

confidence: 71%

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

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“…Indeed, RV failure is now recognized as a state where the right ventricle is substantially dilated and associated with systemic congestion. In our study, 43.3% (52/120) of patients considered to show RV failure had an RV/LV EDA ratio greater than or equal to 0.8, which was recently shown to be a strong indicator of RV failure [ 21 ]. Applying a cutoff of 8 mmHg for CVP is supported by a clinical study reporting a worse outcome when CVP is above this value [ 6 ].…”

Section: Discussionmentioning

confidence: 63%

Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness

et al. 2020

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Objective Incidence of right ventricular (RV) failure in septic shock patients is not well known, and tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values. Design Ancillary study of the HEMOPRED prospective multicenter study includes patients under mechanical ventilation with circulatory failure. Setting This is a multicenter intensive care unit study Patients Two hundred and eighty-two patients with septic shock were analyzed. Patients were classified in three groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded. Interventions None. Measurements and main results In total, 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had a normal TAPSE. Conclusions RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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“…TEE was efficient and provided the shortest mean compression pauses duration (up to 9 s) compared with TTE (up to 19 s). An original study of Geri et al showed that TEE monitoring in ICU patients with septic shock can identify cardiovascular clusters that are potentially useful to orientate fluid infusion, vasopressors and inotropic treatment and predict prognosis [11]. The combination of echocardiographic and clinical parameters allows the differentiation of five phenotypes, based on the assessment of left ventricle (LV) or right ventricle depression, LV hyperkinesia, fluid responsiveness and persistent hypovolemia.…”

Section: Echocardiographymentioning

confidence: 99%

Focus on ultrasound in intensive care

2020

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Over the past two decades, the amount of literature on point of care ultrasound (PoCUS) has been increasing rapidly. Nowadays, a growing body of evidence strongly supports its role in several fields with particular interest to the acute care settings. This article will review some recent literature that may be of interest to the critical care community. Our literature review mainly focuses on thoracic PoCUS, including eight articles on lung ultrasound (LUS), six articles on echocardiography and one article on diaphragm ultrasound. We also cite an important review on brain ultrasound, one article on multiorgan PoCUS and two articles on procedure guidance.

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Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis

Cited by 153 publications

References 35 publications

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness

Focus on ultrasound in intensive care

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