Hemodynamic Assessment of Patients With Septic Shock Using Transpulmonary Thermodilution and Critical Care Echocardiography

Vignon, Philippe; Bégot, Emmanuelle; Mari, Arnaud; Silva, Stein; Chimot, Loïc; Delour, Pierre; Vargas, Frédéric; Filloux, Bruno; Vandroux, David; Jabot, Julien; Dalmay, François; Pichon, Nicolas; Clavel, M.; Lévy, Bruno; Slama, Michel; Riu-Poulenc, Béatrice

doi:10.1016/j.chest.2017.08.022

Cited by 50 publications

(48 citation statements)

References 39 publications

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“…A recent study showed moderate consistency in hemodynamic assessment of mechanically ventilated patients with septic shock using PiCCO and CCM echocardiography [12]. The correlation between CO calculated by manual VTI and CO measured by PiCCO is about 0.95 as reported previously [13].…”

Section: Discussionsupporting

confidence: 64%

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

Fang¹,

Lv²,

Zhou³

et al. 2020

Preprint

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Background: To compare safety and clinical efficacy of artificial intelligence (AI)-powered ultrasound with pulse index continuous cardiac output (PiCCO) for monitoring critically ill patients.Methods: Patients who were admitted to our hospital from April to June 2020 were recruited. PiCCO was employed to monitor cardiac output (CO) and extravascular lung water index (ELWI). Simultaneously, an AI-powered ultrasound was used to automatically monitor CO and the left ventricular outflow tract velocity time integral (LVOT-VTI), and Lung ultrasound B line.Results: A total of 41 patients were enrolled, the male/female ratio was 26:15, and the patients’ median age was 73.6±8.85 years old. There was no significant difference between PiCCO and AI-powered ultrasound in monitoring of CO (t = 1.01, P = 0.316), and the correlation between these two techniques was significant (r=0.911; 95% confidence interval (CI): [0.82; 0.96]; P < 0.001). Similarly, the correlation between lung ultrasound and ELWI was significant r=0.770 (95%CI: [0.58; 0.88]; P < 0.001). Conclusions: Clinical management of critically ill patients can be achieved via monitoring techniques, such as PICCO and AI-powered ultrasound.

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Section: Discussionsupporting

confidence: 64%

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

Fang¹,

Lv²,

Zhou³

et al. 2020

Preprint

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“…Planning optimal fluid and inotrope-vasopressorinodilator management in critically ill pediatric patients is important. In children with shock, of any etiology, cardiac output measurement plays an important role in guiding fluid and inotrope treatment [11].…”

Section: Discussionmentioning

confidence: 99%

“…The time course of transpulmonary thermodilution derived parameters may have clinical relevance in pediatric critical care practice [25]. Vignon et al [11] compared transthoracic echocardiographic CO measurements performed with the CO measurements performed by transpulmonary thermodilution method in mechanically ventilated adult patients with septic shock and they reported that there is a mid-level concordance between the measurements. In a study which compared CO values measured by transthoracic echocardiography with the CO values measured with PiCCO in post cardiac arrest patients on therapeutic hypothermia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of cardiac output and cardiac index values measured by critical care echocardiography with the values measured by pulse index continuous cardiac output (PiCCO) in the pediatric intensive care unit:a preliminary study

et al. 2020

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Background: Planning optimal fluid and inotrope-vasopressor-inodilator therapy is essential in critically ill children. Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamic monitor that provides parameter measurements such as cardiac output (CO), cardiac index (CI). Use of ultrasonography and critical care echocardiography by the pediatric intensivists has increased in recent years. In the hands of an experienced pediatric intensivist, critical echocardiography can accurately measure both CO and CI. Our objective in this study is to compare the CO and CI values measured by pediatric intensivist using critical care echocardiography to the values measured by PiCCO monitor in critically ill pediatric patients. Methods: A prospective observational study from a tertiary university hospital PICU. A total of 15 patients who required advanced hemodynamic monitoring and applied PiCCO monitoring were included the study. The diagnosis of patients were septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Forty nine echocardiographic measurements were performed and from 15 patients. All echocardiographic measurements were performed by a pediatric intensive care fellow experienced in cardiac ultrasound. The distance of left ventricle outflow tract (LVOT) in the parasternal long axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) were calculated using these two measurements. PiCCO (PiCCO, Pulsion Medical Systems, Munich, Germany) monitoring was performed. Cardiac output (CO_picco) and CI (CI_picco) were simultaneously measured by PiCCO monitor and echocardiography. We performed a correlation analysis with this 49 echocardiographic measurements and PiCCO measurements.

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“…TTE is a valuable tool for monitoring haemodynamics bedside [27]; it can easily provide dynamic haemodynamic parameters [28] and information about heart-lung interactions in mechanically ventilated patients [29]. It can comprehensively assess the structure and function of the heart and valves, stroke volume, ejection fraction, etc., provide physicians with speci c and direct information about left and right ventricular functions, and provide many other options to assess uid status or pharmacological demand [30,31].…”

Section: Discussionmentioning

confidence: 99%

Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.

Jiang

Chen

et al. 2020

Preprint

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Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

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Hemodynamic Assessment of Patients With Septic Shock Using Transpulmonary Thermodilution and Critical Care Echocardiography

Cited by 50 publications

References 39 publications

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

Comparing Clinical Efficacy of Artificial Intelligence-powered Ultrasound with Pulse Index Continuous Cardiac Output for Monitoring Critically ill Patients

Comparison of cardiac output and cardiac index values measured by critical care echocardiography with the values measured by pulse index continuous cardiac output (PiCCO) in the pediatric intensive care unit:a preliminary study

Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.

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