Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients

Chauvet, Jean-Louis; El-Dash, Shari; Delastre, O.; Bouffandeau, B; Jusserand, Dominique; Michot, J B; Bauer, Fabrice; Maizel, Julien; Slama, Michel

doi:10.1186/s13054-015-0980-z

Cited by 57 publications

(46 citation statements)

References 23 publications

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“…In most of these patients, fluid infusion decreased this obstruction, increased cardiac output, and clinically improved the patient [48]. Pending confirmation and prospective validation, LVOTO may be considered a new fluid-responsiveness parameter.…”

Section: Future Directionsmentioning

confidence: 99%

Echocardiography as a guide for fluid management

et al. 2016

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BackgroundIn critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management. We also provide new data to help clinicians anticipate bedside echocardiography findings in vasopressor-dependent, volume-resuscitated patients.ObjectiveTo review bedside ultrasound as a method to judge whether additional intravenous fluid will increase cardiac output. Special emphasis is placed on the respiratory effort of the patient.ConclusionsPoint-of-care echocardiography has the unique ability to screen for unexpected structural findings while providing a quantifiable probability of a patient’s cardiovascular response to fluids. Measuring changes in stroke volume in response to either passive leg raising or changes in thoracic pressure during controlled mechanical ventilation offer good performance characteristics but may be limited by operator skill, arrhythmia, and open lung ventilation strategies. Measuring changes in vena caval diameter induced by controlled mechanical ventilation demands less training of the operator and performs well during arrythmia. In modern delivery of critical care, however, most patients are nursed awake, even during mechanical ventilation. In patients making respiratory efforts we suggest that ventilator settings must be standardized before assessing this promising technology as a guide for fluid management.

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Section: Future Directionsmentioning

confidence: 99%

Echocardiography as a guide for fluid management

et al. 2016

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“…For example, selective digestive decontamination with antibiotics for intestinal pathogen suppression is the most efficacious VAP preventive measure [38], yet has limited clinical adoption due to concerns for inducing antibiotic resistance. Extensive research supports that probiotics are safe, and potentially efficacious in several critical care settings [39]. However, notable safety exceptions, as in the case of acute pancreatitis [40] and lack of efficacy in recent phase II [41] or III [42] clinical trials highlight the need for refinement of probiotic design, strain and dosage selection and host-microbiome targeting.…”

Section: Why Should We Study the Microbiome In Critical Illness?mentioning

confidence: 99%

Dysbiosis in the intensive care unit: Microbiome science coming to the bedside

Kitsios

Morowitz

Dickson

et al. 2017

Journal of Critical Care

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Complex microbial communities within the human body, constituting the microbiome, have a broad impact on human health and disease. A growing body of research now examines the role of the microbiome in patients with critical illness, such as sepsis and acute respiratory failure. In this article, we provide an introduction to microbiome concepts and terminology and we systematically review the current evidence base of the critical-illness microbiome, including 51 studies in animal models and pediatric and adult critically-ill patients. We further examine how this emerging scientific discipline may transform the way we manage infectious and inflammatory diseases in intensive care units. The evolving molecular, culture-independent techniques offer the ability to study microbial communities in unprecedented depth and detail, and in the short-term, may enable us to diagnose and treat infections in critical care more precisely and effectively. Longer-term, these tools may also give us insights in the underlying pathophysiology of critical illness and reveal previously unsuspected targets for innovative, microbiome-targeted therapeutics. We finally propose a roadmap for future studies in the field for transforming critical care from its current isolated focus on the host to a more personalized paradigm addressing both human and microbial contributions to critical illness.

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“…The administration of betastimulation in poorly controlled preload causes tachycardia, shortens diastolic filling times and leads to falsely elevated static parameters in a hypovolaemic patient. In the context of low afterload, this may also lead to left ventricular outflow tract obstruction which is, in the context of EGDT, reported in high rates (22% [38]). Not surprisingly, ceasing betastimulation as part of EGDT and the administration of low-dose betablockers with the correction of preload has led to a dramatic decrease in mortality [39].…”

Section: Fluid Therapy Vs Diastolic Dysfunctionmentioning

confidence: 99%

Management of arrhythmia in sepsis and septic shock

Borggrefe¹,

Matoušek²,

Malý³

et al. 2017

Anaesthesiol Intensive Ther

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The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.

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Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients

Cited by 57 publications

References 23 publications

Echocardiography as a guide for fluid management

Echocardiography as a guide for fluid management

Dysbiosis in the intensive care unit: Microbiome science coming to the bedside

Management of arrhythmia in sepsis and septic shock

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