Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin, Arnaldo; Loudet, Cecilia; Edul, Vanina Siham Kanoore; Osatnik, Javier; Ríos, Fernando; Vásquez, Daniela N.; Pozo, Mario Omar; Lattanzio, Bernardo; Pálizas, Fernando; Klein, Francisco; Piezny, Damián; Birri, Paolo Nahuel Rubatto; Tuhay, Graciela; García, Analia Paola; Santamaría, Analía; Zakalik, Graciela; González, Cecilia; Bakker, Jan

doi:10.1186/s13613-020-00659-7

Cited by 23 publications

(14 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, this study done 7 years ago may not reflect current practice anymore. The behaviour of our respondents is supported by recent studies showing outcome benefits when predicting fluid responsiveness in septic patients [23] , [24] . Echo was ranked #1 for the prediction of fluid responsiveness, globally and in the 3 main regions.…”

Section: Discussionsupporting

confidence: 77%

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

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 77%

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

Michard

Malbrain

Martin

et al. 2020

Anaesthesia Critical Care & Pain Medicine

View full text Add to dashboard Cite

show abstract

“…However, overzealous IV fluid resuscitation is associated with poor patient outcome and attempts are being made to clarify patient subsets at particular risk [ 14 , 15 , 16 , 17 , 18 ]. Initially, the invasive monitoring of cardiac filling pressures guided IV fluid administration, but the central venous pressure (CVP) and pulmonary artery occlusion pressure (Ppao) neither definitely describe a patient’s volume status, nor how stroke volume (SV) will respond to additional preload [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Kenny

2022

Medical Sciences

View full text Add to dashboard Cite

Ultrasonography is becoming the favored hemodynamic monitoring utensil of emergentologists, anesthesiologists and intensivists. While the roles of ultrasound grow and evolve, many clinical applications of ultrasound stem from qualitative, image-based protocols, especially for diagnosing and managing circulatory failure. Often, these algorithms imply or suggest treatment. For example, intravenous fluids are opted for or against based upon ultrasonographic signs of preload and estimation of the left ventricular ejection fraction. Though appealing, image-based algorithms skirt some foundational tenets of cardiac physiology; namely, (1) the relationship between cardiac filling and stroke volume varies considerably in the critically ill, (2) the correlation between cardiac filling and total vascular volume is poor and (3) the ejection fraction is not purely an appraisal of cardiac function but rather a measure of coupling between the ventricle and the arterial load. Therefore, management decisions could be enhanced by quantitative approaches, enabled by Doppler ultrasonography. Both fluid ‘responsiveness’ and ‘tolerance’ are evaluated by Doppler ultrasound, but the physiological relationship between these constructs is nebulous. Accordingly, it is argued that the link between them is founded upon the Frank–Starling–Sarnoff relationship and that this framework helps direct future ultrasound protocols, explains seemingly discordant findings and steers new routes of enquiry.

show abstract

“…Studies of sepsis protocols in LMICs to date have largely used bedside assessment of volume status to direct care, including the following: symptoms or signs of respiratory distress [ 12 ], > = 3% decrease in oxygen saturation [ 9 , 13 ], increase respiratory rate of > = 5 breaths per minute [ 9 , 13 ], jugular venous pressure > = 3 cm above the sternal angle [ 9 ], or new crackles [ 13 ]. Dubin at al.’s [ 37 ] prospective cohort conducted in Argentina specifically evaluated the impact of dynamic tests of fluid responsiveness which included both noninvasive and invasive measures and found use of dynamic fluid assessment independently associated with reduced mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis

et al. 2022

View full text Add to dashboard Cite

Background Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context. Methods We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student’s t-test to compare group means for percentage of scenarios with correct diagnosis. Results A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98–1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88–1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges. Conclusion We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation. Trial registration Open Science Framework osf.io/ju4ga. Registered June 28, 2017

show abstract

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Cited by 23 publications

References 56 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

Assessing Fluid Intolerance with Doppler Ultrasonography: A Physiological Framework

Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis

Contact Info

Product

Resources

About