Echo–Doppler Demonstration of Acute Cor Pulmonale at the Bedside in the Medical Intensive Care Unit

Vieillard‐Baron, Antoine; Prin, Sébastien; Chergui, Karim; Dubourg, Olivier; Jardin, François

doi:10.1164/rccm.200202-146cc

Cited by 287 publications

(164 citation statements)

References 36 publications

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“…16 Acute cor pulmonale, clinically defined as sudden pressure overload and failure of the RV, 17 is the most likely etiology of our patient's acute RV failure and subsequent hemodynamic collapse. Sternal retraction and manipulation of the heart may have precipitated acute obstruction of the RV outflow tract by the tumour.…”

Section: Discussionmentioning

confidence: 94%

Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

Flexman

Vicario

Schwarz

2009

Can J Anesth/J Can Anesth

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Purpose To describe a case of acute right ventricular dysfunction and hemodynamic collapse under general anesthesia in a patient undergoing resection of a pulmonary artery sarcoma. Clinical features A 67-yr-old woman with a presumptive diagnosis of pulmonary embolism presented to the hospital with progressive shortness of breath and syncope despite therapeutic anticoagulation. An echocardiogram revealed a large mass in the main pulmonary artery and a right ventricular systolic pressure of 105 mmHg. She was referred to our centre for urgent surgical management.

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Section: Discussionmentioning

confidence: 94%

Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

Flexman

Vicario

Schwarz

2009

Can J Anesth/J Can Anesth

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“…The reasons for such RV failure are many, and all lead to acute pulmonary hypertension and increased RV afterload: lung inflammation induces pulmonary vascular injury (42), hypoxemia and respiratory acidosis induce pulmonary vasoconstriction and mechanical ventilation may induce a vascular waterfall at the level of the pulmonary capillaries (43). In this situation, RV failure is detected by echocardiography as a pattern of acute cor pulmonale (ACP), which associates RV dilatation and paradoxical septal motion, without significant RV hypertrophy (44). Risk factors for ACP are pneumoniarelated ARDS, PaO 2 /FiO 2 <150 mmHg, driving pressure ≥18 cmH 2 O and PaCO 2 ≥48 mmHg, with an incidence of ACP less than 10% in the absence of risk factors, but of 60% when four risk factors are present (37).…”

Section: Pplatmentioning

confidence: 99%

On the complexity of scoring acute respiratory distress syndrome: do not forget hemodynamics!

Repessé¹,

Aubry²,

Vieillard‐Baron³

2016

J. Thorac. Dis.

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Acute respiratory distress syndrome (ARDS) remains associated with a poor outcome despite recent major therapeutic advances. Forecasting the outcome of patients suffering from such a syndrome is of a crucial interest and many scores have been proposed, all suffering from limits responsible for important discrepancies. Authors try to elaborate simple, routine and reliable scores but most of them do not consider hemodynamics yet acknowledged as a major determinant of outcome. This article aims at reminding the approach of scoring in ARDS and at deeply describing the most recently published one in order to highlight their main pitfall, which is to forget the hemodynamics.

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“…But CCE is also able to evaluate right heart function accurately [10], to detect acute cor pulmonale in different situations [11], and to recognise left ventricular (LV) dysfunction using the LV ejection fraction or its surrogate LV fractional area contraction [12]. All the potential causes of circulatory failure may be independently evaluated from the others, like direct visualisation of the cardiac chambers and heart function, in contrast to what can be done using other devices.…”

Section: Reason 1: Measures Relevant Variablesmentioning

confidence: 99%

Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU

Charron¹,

Repessé²,

Bodson³

et al. 2014

Anaesthesiol Intensive Ther

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Critical care ultrasonography (CCUS) has been defined as an ultrasound evaluation of the heart, abdomen, pleura and lungs at the bedside by the intensivist, 24/7. Within CCUS, critical care echocardiography (CCE) is used to assess cardiac function and more generally haemodynamics. Experts in haemodynamics have published a 'consensus of 16' regarding an update on haemodynamic monitoring. They reported the ten key properties of an 'ideal' haemodynamic monitoring system, which perfectly match the ten good reasons we describe here for performing CCE in critically ill patients. Even though unfortunately no evidence-based medicine study is available to support this review, especially regarding CCE-related improvement of outcome, many clinical studies have demonstrated that CCE provides measurements of relevant, accurate, reproducible and interpretable variables, is easy to use, readily available, has a rapid response time, causes no harm, and is cost-effective. Whether it is operator-independent is obviously more debatable and is discussed in this review. All these characteristics are arguments for the extensive use of CCE by intensivists. This is why experts in the field have recommended that a basic level of CCE should be included in the training of all intensivists.

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Echo–Doppler Demonstration of Acute Cor Pulmonale at the Bedside in the Medical Intensive Care Unit

Cited by 287 publications

References 36 publications

Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

Hemodynamic collapse under anesthesia in a patient with pulmonary artery sarcoma

On the complexity of scoring acute respiratory distress syndrome: do not forget hemodynamics!

Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU

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