The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Hugh W F Kingston - One of the best experts on this subject based on the ideXlab platform.
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reduced Cardiac Index reserve and hypovolemia in severe falciparum malaria
The Journal of Infectious Diseases, 2020Co-Authors: Hugh W F Kingston, Aniruddha Ghose, Voravut Rungpradubvong, Sudarat Satitthummanid, Trent M Herdman, Katherine PlewesAbstract:Background: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed Cardiac function and volume status in severe falciparum malaria and its prognostic significance. Methods: Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. Results: Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. Conclusions: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced Cardiac Index reserve.
Jean Louis Vincent - One of the best experts on this subject based on the ideXlab platform.
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can changes in arterial pressure be used to detect changes in Cardiac Index during fluid challenge in patients with septic shock
Intensive Care Medicine, 2012Co-Authors: Charalampos Pierrakos, Dimitrios Velissaris, Sabino Scolletta, Sarah Heenen, Daniel De Backer, Jean Louis VincentAbstract:Response to fluid challenge is often defined as an increase in Cardiac Index (CI) of more than 10–15%. However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock. This was an observational study in which we reviewed prospectively collected data from 51 septic shock patients in whom complete hemodynamic measurements had been obtained before and after a fluid challenge with 1,000 ml crystalloid (Hartman’s solution) or 500 ml colloid (hydroxyethyl starch 6%). CI was measured using thermodilution. Patients were divided into two groups (responders and non-responders) according to their change in CI (responders: %CI >10%) after the fluid challenge. Statistical analysis was performed using a two-way analysis of variance test followed by a Student’s t test with adjustment for multiple comparisons. Pearson’s correlation and receiver operating characteristic curve analysis were also used. Mean patient age was 67 ± 17 years and mean Sequential Organ Failure Assessment (SOFA) upon admittance to the intensive care unit was 10 ± 3. In the 25 responders, MAP increased from 69 ± 9 to 77 ± 9 mmHg, pulse pressure (PP) increased from 59 ± 15 to 67 ± 16, and CI increased from 2.8 ± 0.8 to 3.4 ± 0.9 L/min/m2 (all p < 0.001). There were no significant correlations between the changes in MAP, PP, and CI. Changes in MAP do not reliably track changes in CI after fluid challenge in patients with septic shock and, consequently, should be interpreted carefully when evaluating the response to fluid challenge in such patients.
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can changes in arterial pressure be used to detect changes in Cardiac Index during fluid challenge in patients with septic shock
Intensive Care Medicine, 2012Co-Authors: Charalampos Pierrakos, Dimitrios Velissaris, Sabino Scolletta, Sarah Heenen, Daniel De Backer, Jean Louis VincentAbstract:Purpose Response to fluid challenge is often defined as an increase in Cardiac Index (CI) of more than 10–15%. However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock.
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DETERMINATION OF OXYGEN DELIVERY AND CONSUMPTION VERSUS Cardiac Index AND OXYGEN EXTRACTION RATIO
Critical care clinics, 1996Co-Authors: Jean Louis VincentAbstract:Measuring Cardiac output without knowledge of the oxygen extraction by the tissues is of limited value. Instead of calculating oxygen consumption and oxygen delivery, a diagram relating Cardiac Index to the oxygen extraction ratio is proposed to interpret hemodynamic data at the bedside. This diagram is particularly helpful in interpreting Cardiac Index in the presence of changes in hemoglobin or oxygen demands and in evaluating the effects of therapy.
Jeanlouis Teboul - One of the best experts on this subject based on the ideXlab platform.
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the estimation of Cardiac output by the nexfin device is of poor reliability for tracking the effects of a fluid challenge
Critical Care, 2012Co-Authors: Xavier Monnet, Christian Richard, Fabien Picard, Elsa Lidzborski, Malcie Mesnil, Jacques Duranteau, Jeanlouis TeboulAbstract:Introduction The Nexfin device estimates arterial pressure by the volume clamp method through a finger pneumatic cuff. It also allows to estimate Cardiac Index (CInoninv) by pulse contour analysis of the non-invasive arterial pressure curve. We evaluated the ability of the device to track changes in Cardiac Index induced by a fluid challenge.
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prediction of fluid responsiveness by a continuous non invasive assessment of arterial pressure in critically ill patients comparison with four other dynamic indices
BJA: British Journal of Anaesthesia, 2012Co-Authors: Xavier Monnet, Christian Richard, Martin Dres, A Ferre, Le G Teuff, Mathieu Jozwiak, A Bleibtreu, M Le C Deley, Denis Chemla, Jeanlouis TeboulAbstract:Background We evaluated the ability of an infrared photoplethysmography arterial waveform (continuous non-invasive arterial pressure, CNAP) to estimate arterial pulse pressure variation (PPV). We compared the ability of non-invasive PPV to predict fluid responsiveness with invasive PPV, respiratory variation of pulse contour-derived stroke volume, and changes in Cardiac Index induced by passive leg raising (PLR) and end-expiratory occlusion (EEO) tests. Methods We measured the responses of Cardiac Index (PiCCO) to 500 ml of saline in 47 critically ill patients with haemodynamic failure. Before fluid administration, we recorded non-invasive and invasive PPVs, stroke volume variation, and changes in Cardiac Index induced by PLR and by 15 s EEO. Logistic regressions were performed to investigate the advantage of combining invasive PPV, stroke volume variation, PLR, and EEO when predicting fluid responsiveness. Results In eight patients, CNAP could not record arterial pressure. In the 39 remaining patients, fluid increased Cardiac Index by ≥15% in 17 ‘responders’. Considering the 195 pairs of measurements, the bias ( sd ) between invasive and non-invasive PPVs was −0.6 (2.3)%. The areas under the receiver operating characteristic (ROC) curves for predicting fluid responsiveness were 0.89 (95% confidence interval, 0.78–1.01) for non-invasive PPV compared with 0.89 (0.77–1.01), 0.84 (0.70–0.96), 0.95 (0.88–1.03), and 0.97 (0.91–1.03) for invasive pulse pressure, stroke volume variations, PLR, and EEO tests (no significant difference). Combining multiple tests did not significantly improve the area under the ROC curves. Conclusions Non-invasive assessment of PPV seems valuable in predicting fluid responsiveness.
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respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock
Chest, 2001Co-Authors: M Feissel, Frederic Michard, Isabelle Mangin, O Ruyer, Jeanpierre Faller, Jeanlouis TeboulAbstract:Study objective: To investigate whether the respiratory changes in peak velocity (Vpeak) of aortic blood flow could be related to the effects of volume expansion on Cardiac Index. Design: Prospective clinical study. Setting: Medical ICUs of a university hospital (20 beds) and of a nonuniversity hospital (15 beds). Patients: Nineteen sedated septic shock patients who were receiving mechanical ventilation and who had preserved left ventricular (LV) systolic function. Intervention: Volume expansion. Measurements and results: Analysis of aortic blood flow by transesophageal echocardiography allowed beat-to-beat measurement of Vpeak before and after volume expansion. Maximum values of Vpeak (Vpeakmax) and minimum values of Vpeak (Vpeakmin) were determined over one respiratory cycle. The respiratory changes in Vpeak (DVpeak) were calculated as the difference between Vpeakmax and Vpeakmin divided by the mean of the two values and were expressed as a percentage. The Indexed LV end-diastolic area (EDAI) and Cardiac Index were obtained at the end of the expiratory period. The volume expansion-induced increase in Cardiac Index was > 15% in 10 patients (responders) and < 15% in 9 patients (nonresponders). Before volume expansion, DVpeak was higher in responders than in nonresponders (20 6 6% vs 10 6 3%; p < 0.01), while EDAI was not significantly different between the two groups (9.7 6 3.7 vs 9.7 6 2.4 cm 2 /m 2 ). Before volume expansion, a DVpeak threshold value of 12% allowed discrimination between responders and nonresponders with a sensitivity of 100% and a specificity of 89%. Volume expansion-induced changes in Cardiac Index closely correlated with the DVpeak before volume expansion (r 2 5 0.83; p < 0.001). Conclusion: Analysis of respiratory changes in aortic blood velocity is an accurate method for predicting the hemodynamic effects of volume expansion in septic shock patients receiving mechanical ventilation who have preserved LV systolic function. (CHEST 2001; 119:867‐ 873)
Katherine Plewes - One of the best experts on this subject based on the ideXlab platform.
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reduced Cardiac Index reserve and hypovolemia in severe falciparum malaria
The Journal of Infectious Diseases, 2020Co-Authors: Hugh W F Kingston, Aniruddha Ghose, Voravut Rungpradubvong, Sudarat Satitthummanid, Trent M Herdman, Katherine PlewesAbstract:Background: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed Cardiac function and volume status in severe falciparum malaria and its prognostic significance. Methods: Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. Results: Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. Conclusions: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced Cardiac Index reserve.
Voravut Rungpradubvong - One of the best experts on this subject based on the ideXlab platform.
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reduced Cardiac Index reserve and hypovolemia in severe falciparum malaria
The Journal of Infectious Diseases, 2020Co-Authors: Hugh W F Kingston, Aniruddha Ghose, Voravut Rungpradubvong, Sudarat Satitthummanid, Trent M Herdman, Katherine PlewesAbstract:Background: Impaired microvascular perfusion is central to the development of coma and lactic acidosis in severe falciparum malaria. Refractory hypotension is rare on admission but develops frequently in fatal cases. We assessed Cardiac function and volume status in severe falciparum malaria and its prognostic significance. Methods: Patients with severe (N = 101) or acute uncomplicated falciparum malaria (N = 83) were recruited from 2 hospitals in India and Bangladesh, and healthy participants (N = 44) underwent echocardiography. Results: Patients with severe malaria had 38% shorter left ventricular (LV) filling times and 25% shorter LV ejection times than healthy participants because of tachycardia; however, stroke volume, LV internal diameter in diastole (LVIDd), and LV internal diameter in systole (LVIDs) indices were similar. A low endocardial fraction shortening (eFS) was present in 17% (9 of 52) of severe malaria patients. Adjusting for preload and afterload, eFS was similar in health and severe malaria. Fatal cases had smaller baseline LVIDd and LVIDs indices, more collapsible inferior vena cavae (IVC), and higher heart rates than survivors. The LVIDs and IVC collapsibility were independent predictors for mortality, together with base excess and Glasgow Coma Scale. Conclusions: Patients with severe malaria have rapid ejection of a normal stroke volume. Fatal cases had features of relative hypovolemia and reduced Cardiac Index reserve.