19 results on '"X. Monnet"'
Search Results
2. Parameters of fluid responsiveness.
- Author
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Shi R, Monnet X, and Teboul JL
- Subjects
- Blood Pressure, Humans, Reproducibility of Results, Respiration, Artificial, Stroke Volume, Tidal Volume, Fluid Therapy, Hemodynamics
- Abstract
Purpose of Review: On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness., Recent Findings: Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart-lung interaction tests have been developed. The tidal volume challenge may overcome the limitation of low tidal volume ventilation. Preliminary data suggest that changes in pulse pressure variation during this test well predict fluid responsiveness. Growing evidence confirms the good predictive performance of the end-expiratory occlusion test. All these dynamic tests allow selecting appropriate fluid responders and preventing excessive fluid administration. Performance of a mini-fluid challenge may help for the decision-making process of fluid management if other tests are not available., Summary: Several new dynamic variables and monitoring techniques to predict fluid responsiveness were investigated in the past years. Nevertheless, further research investigating their reliability and feasibility in larger cohorts is warranted. VIDEO ABSTRACT.
- Published
- 2020
- Full Text
- View/download PDF
3. End-Expiratory Occlusion Test to Predict Fluid Responsiveness Is Not Suitable for Laparotomic Surgery.
- Author
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Weil G, Motamed C, Monnet X, Eghiaian A, and Le Maho AL
- Subjects
- Adult, Aged, Crystalloid Solutions adverse effects, Female, Humans, Infusions, Parenteral, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Time Factors, Crystalloid Solutions administration & dosage, Fluid Therapy adverse effects, Hemodynamics, Laparotomy adverse effects, Monitoring, Intraoperative methods, Respiration, Artificial
- Abstract
Background: The end-expiratory occlusion test predicts fluid responsiveness in ventilated intensive care patients; however, its utility in the operating room is questioned. We assessed end-expiratory occlusion test in laparotomic surgery for predicting volume expansion., Methods: Forty-six patients were included in this study: stage 1 (n = 26) with an end-expiratory occlusion test of 15 seconds, followed by volume expansion, which consisted of 250 mL of colloid over 5 minutes and stage 2 (n = 20) with an end-expiratory occlusion test of 25 seconds followed by volume expansion. The last 10 patients had transdiaphragmatic pressures probed. Patients with an increase in cardiac index >15% after volume expansion were responders. Pulse pressure variation, stroke volume (SV) index, and cardiac index were analyzed. Receiver operating characteristic curves were established for changes in SV and pulse pressure induced by end-expiratory occlusion test and pulse pressure variation using the responders status for volume expansion as outcome., Results: A total of 44 (38%) volume expansions were deemed responders. After end-expiratory occlusion test of 15 seconds, no hemodynamic variables were significantly increased. After end-expiratory occlusion test of 25 seconds, SV index increased in responders (37.1 ± 8.8 mL/m after end-expiratory occlusion test of 25 seconds versus 35.7 ± 8.6 before; P < .0001). End-expiratory occlusion test could not discriminate responders from nonresponders. Only pulse pressure variation had significantly different area under the curve from that expected by chance (0.7 [0.57-0.81]; P = .002 for end-expiratory occlusion test of 15 seconds; and 0.78 [0.64-0.89]; P = .0001 for end-expiratory occlusion test of 25 seconds). After laparotomy, gastric pressure decreased significantly (4 [2.75-5] vs 2 [2-4] cm H2O; P = .0417); no difference was noticed in the transdiaphragmatic gradient., Conclusions: End-expiratory occlusion test was not reliable to discriminate responders from nonresponders after volume expansion during laparotomic surgery.
- Published
- 2020
- Full Text
- View/download PDF
4. Comparison of Proaqt/Pulsioflex ® and oesophageal Doppler for intraoperative haemodynamic monitoring during intermediate-risk abdominal surgery.
- Author
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Weil G, Motamed C, Eghiaian A, Monnet X, and Suria S
- Subjects
- Adult, Aged, Blood Pressure, Calibration, Cardiac Output, Female, Fluid Therapy, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Stroke Volume, Abdomen surgery, Esophagus surgery, Hemodynamic Monitoring methods, Hemodynamics, Monitoring, Intraoperative methods
- Abstract
Objective: To compare cardiac index (CI) between Proaqt/PulsioFlex
® and oesophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI., Methods: In a single hospital, 49 intermediate-risk oncologic abdominal surgery patients were included in an observational study. We measured the cardiac Index (CI) provided by OD and by the Proaqt/PulsioFlex® before and after internal calibration, which were performed randomly at specific intervals after the initial one (30, 60, 90 and 120min). The ability to track fluid responsiveness was evaluated by measuring stroke volume variation, pulse pressure variation (PPV) and CI before and after a 250ml fluid challenge and assessed by a receiver operating characteristic curve analysis., Results: The percentages of error before calibration were 51, 58, 82, 81% for 30, 60, 90 and 120min, they were 39, 57, 65, and 54% after calibration. Trending ability is assumed by a 93% concordance rate after applying a 15% exclusion zone. The trend interchangeability rate was 13.75%. The area under the curve for fluid responsiveness measured by PPV and SVV PulsioFlex were respectively 0.67 [0.57-0.77], P<0.01 and 0.75 [0.47-0.66], which was not clinically relevant., Conclusions: The Proaqt/Pulsioflex® system is not equivalent to OD for haemodynamic monitoring during non-vascular abdominal surgery in intermediate-risk patients. More studies are required to define the effect of the auto-calibration on the system., (Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
5. The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients.
- Author
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Beurton A, Teboul JL, Gavelli F, Gonzalez FA, Girotto V, Galarza L, Anguel N, Richard C, and Monnet X
- Subjects
- Aged, Cardiac Output physiology, Critical Illness, Female, Humans, Leg blood supply, Leg physiopathology, Linear Models, Male, Middle Aged, Monitoring, Physiologic methods, Monitoring, Physiologic trends, Oxygen blood, Plethysmography instrumentation, Prospective Studies, ROC Curve, Shock blood, Shock physiopathology, Hemodynamics physiology, Oxygen analysis, Plethysmography methods
- Abstract
Background: A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way., Methods: In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline)., Results: Three patients were excluded because the plethysmography signal was absent and 3 other ones because it was unstable. Eventually, 72 patients were analysed. In 34 patients with a positive PLR test (increase in CI ≥ 10%), CI and PI increased during PLR by 21 ± 10% and 54 ± 53%, respectively. In the 38 patients with a negative PLR test, PI did not significantly change during PLR. In 26 patients in whom volume expansion was performed, CI and PI increased by 28 ± 14% and 53 ± 63%, respectively. The correlation between the PI and CI changes for all interventions was significant (r = 0.64, p < 0.001). During the PLR test, if PI increased by > 9%, a positive response of CI (≥ 10%) was diagnosed with a sensitivity of 91 (76-98%) and a specificity of 79 (63-90%) (area under the receiver operating characteristics curve 0.89 (0.80-0.95), p < 0.0001)., Conclusion: An increase in PI during PLR by 9% accurately detects a positive response of the PLR test., Trial Registration: ID RCB 2016-A00959-42. Registered 27 June 2016.
- Published
- 2019
- Full Text
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6. Pressure Waveform Analysis.
- Author
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Jozwiak M, Monnet X, and Teboul JL
- Subjects
- Humans, Monitoring, Physiologic methods, Thermodilution methods, Blood Pressure physiology, Cardiac Output physiology, Hemodynamics physiology, Monitoring, Intraoperative methods, Wavelet Analysis
- Abstract
Monitoring cardiac output is of special interest for detecting early hemodynamic impairment and for guiding its treatment. Among the techniques that are available to monitor cardiac output, pressure waveform analysis estimates cardiac output from the shape of the arterial pressure curve. It is based on the general principle that the amplitude of the systolic part of the arterial curve is proportional to cardiac output and arterial compliance. Such an estimation of cardiac output has the advantage of being continuous and in real time. With "calibrated" devices, the initial estimation of cardiac output by pressure waveform analysis is calibrated by measurements of cardiac output made by transpulmonary thermal or lithium dilution. Later, at each time transpulmonary dilution is performed, the estimation by pressure waveform analysis, which may drift over time, is calibrated again. By contrast, uncalibrated devices do not use any independent measurement of cardiac output. Unlike calibrated devices, they can be plugged to any arterial catheter. Nevertheless, uncalibrated devices are not reliable in cases of significant short-term changes in arterial resistance, as for instance in patients undergoing liver surgery or those with vasodilatory shock receiving vasopressors. Perioperative hemodynamic monitoring is recommended for high-risk surgical patients since it reduces the number of complications in these patients. The pressure waveform analysis monitoring, especially with uncalibrated devices, is suitable for this purpose. In the intensive care setting, hemodynamic monitoring is recommended for patients with acute circulatory failure, who do not respond to initial therapy. Since these patients often experience large changes in arterial resistance, either spontaneously or due to vasoactive drugs, calibrated devices are more suitable in this context. Not only are they more reliable than uncalibrated devices but also they provide a comprehensive hemodynamic assessment through measurements of a variety of transpulmonary thermodilution-related variables. In this review, we summarize the characteristics of the monitoring devices using the pressure waveform analysis and discuss the appropriate use of different devices in the perioperative and intensive care unit settings.
- Published
- 2018
- Full Text
- View/download PDF
7. Assessment of fluid responsiveness: recent advances.
- Author
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Monnet X and Teboul JL
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Reproducibility of Results, Blood Pressure physiology, Cardiac Output physiology, Fluid Therapy methods, Hemodynamic Monitoring methods, Hemodynamics physiology, Stroke Volume physiology
- Abstract
Purpose of Review: In the field of prediction of fluid responsiveness, the most recent studies have focused on validating new tests, on clarifying the limitations of older ones, and better defining their modalities., Recent Findings: The limitations of pulse pressure/stroke volume variations are numerous, but recent efforts have been made to overcome these limitations, like in case of low tidal volume ventilation. Following pulse pressure/stroke volume variations, new tests have emerged which assess preload responsiveness by challenging cardiac preload through heart-lung interactions, like during recruitment manoeuvres and end-expiratory/inspiratory occlusions. Given the risk of fluid overload that is inherent to the 'classical' fluid challenge, a 'mini' fluid challenge, made of 100 ml of fluid only, has been developed and investigated in recent studies. The reliability of the passive leg raising test is now well established and the newest publications have mainly aimed at defining several noninvasive estimates of cardiac output that can be monitored to assess its effects., Summary: Research in this field is still very active, such that several indices and tests of fluid responsiveness are now available. They may contribute to reduce excessive fluid balance by avoiding unnecessary fluid administration and, also, by ensuring safe fluid removal.
- Published
- 2018
- Full Text
- View/download PDF
8. Predicting the determinants of volume responsiveness.
- Author
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Monnet X and Pinsky MR
- Subjects
- Female, Humans, Male, Blood Pressure physiology, Cardiac Output physiology, Fluid Therapy methods, Hemodynamics physiology, Plasma Substitutes therapeutic use
- Published
- 2015
- Full Text
- View/download PDF
9. Fluid Therapy: Double-Edged Sword during Critical Care?
- Author
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Benes J, Kirov M, Kuzkov V, Lainscak M, Molnar Z, Voga G, and Monnet X
- Subjects
- Humans, Cardiovascular Diseases physiopathology, Cardiovascular Diseases therapy, Critical Care methods, Fluid Therapy adverse effects, Fluid Therapy methods, Hemodynamics, Monitoring, Physiologic, Shock physiopathology, Shock therapy
- Abstract
Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.
- Published
- 2015
- Full Text
- View/download PDF
10. Minimally invasive monitoring.
- Author
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Monnet X and Teboul JL
- Subjects
- Humans, Blood Pressure physiology, Cardiac Output physiology, Hemodynamics physiology, Monitoring, Physiologic instrumentation, Monitoring, Physiologic methods, Photoplethysmography
- Abstract
Although use of the classic pulmonary artery catheter has declined, several techniques have emerged to estimate cardiac output. Arterial pressure waveform analysis computes cardiac output from the arterial pressure curve. The method of estimating cardiac output for these devices depends on whether they need to be calibrated by an independent measure of cardiac output. Some newer devices have been developed to estimate cardiac output from an arterial curve obtained noninvasively with photoplethysmography, allowing a noninvasive beat-by-beat estimation of cardiac output. This article describes the different devices that perform pressure waveform analysis., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
11. Reply: Prone positioning actually exerts benefits on hemodynamics!
- Author
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Jozwiak M, Teboul JL, and Monnet X
- Subjects
- Female, Humans, Male, Hemodynamics, Patient Positioning methods, Prone Position physiology, Respiratory Distress Syndrome therapy
- Published
- 2014
- Full Text
- View/download PDF
12. Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome.
- Author
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Jozwiak M, Teboul JL, Anguel N, Persichini R, Silva S, Chemla D, Richard C, and Monnet X
- Subjects
- Abdomen physiopathology, Aged, Echocardiography, Transesophageal, Female, Humans, Male, Middle Aged, Oximetry, Positive-Pressure Respiration, Pressure, Respiratory Distress Syndrome diagnostic imaging, Respiratory Distress Syndrome physiopathology, Respiratory Function Tests, Treatment Outcome, Vascular Resistance, Hemodynamics, Patient Positioning methods, Prone Position physiology, Respiratory Distress Syndrome therapy
- Abstract
Rationale: The effects of prone positioning during acute respiratory distress syndrome on all the components of cardiac function have not been investigated under protective ventilation and maximal alveolar recruitment., Objectives: To investigate the hemodynamic effects of prone positioning., Methods: We included 18 patients with acute respiratory distress syndrome ventilated with protective ventilation and an end-expiratory positive pressure titrated to a plateau pressure of 28-30 cm H2O. Before and within 20 minutes of starting prone positioning, hemodynamic, respiratory, intraabdominal pressure, and echocardiographic data were collected. Before prone positioning, preload reserve was assessed by a passive leg raising test., Measurements and Main Results: In all patients, prone positioning increased the ratio of arterial oxygen partial pressure over inspired oxygen fraction, the intraabdominal pressure, and the right and left cardiac preload. The pulmonary vascular resistance decreased along with the ratio of the right/left ventricular end-diastolic areas suggesting a decrease of the right ventricular afterload. In the nine patients with preload reserve, prone positioning significantly increased cardiac index (3.0 [2.3-3.5] to 3.6 [3.2-4.4] L/min/m(2)). In the remaining patients, cardiac index did not change despite a significant decrease in the pulmonary vascular resistance., Conclusions: In patients with acute respiratory distress syndrome under protective ventilation and maximal alveolar recruitment, prone positioning increased the cardiac index only in patients with preload reserve, emphasizing the important role of preload in the hemodynamic effects of prone positioning.
- Published
- 2013
- Full Text
- View/download PDF
13. Passive leg raising: keep it easy!
- Author
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Monnet X and Teboul JL
- Subjects
- Cardiac Output, Diagnostic Tests, Routine methods, Humans, Hemodynamics physiology, Leg, Posture
- Published
- 2010
- Full Text
- View/download PDF
14. Hemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: importance of the volume status.
- Author
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Fougères E, Teboul JL, Richard C, Osman D, Chemla D, and Monnet X
- Subjects
- Adult, Aged, Cardiac Output physiology, Catheterization, Swan-Ganz, Echocardiography, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Ventricular Function, Right physiology, Hemodynamics physiology, Positive-Pressure Respiration methods, Respiratory Distress Syndrome physiopathology, Respiratory Distress Syndrome therapy, Tidal Volume physiology
- Abstract
Objective: The hemodynamic impact of positive end-expiratory pressure in acute respiratory distress syndrome and the underlying mechanisms have not been extensively investigated during low stretch ventilation. Our aim was to evaluate the hemodynamic effect of increasing positive end-expiratory pressure when tidal volume and the plateau pressure are limited and to explore the underlying mechanisms., Design: Prospective study., Setting: Medical intensive care unit., Patients: Twenty-one acute respiratory distress syndrome patients ventilated with a tidal volume of 6.0 +/- 0.5 mL/kg of predicted body weight., Intervention: Positive end-expiratory pressure was significantly increased from 5 +/- 1 cm H2O to 13 +/- 4 cm H2O for reaching a plateau pressure of 30 +/- 1 cm H2O. At high positive end-expiratory pressure, passive leg raising was performed for increasing the central blood volume., Measurements: We performed echocardiography and pulmonary artery catheterization during positive end-expiratory pressure increase and during passive leg raising at high positive end-expiratory pressure., Main Results: With positive end-expiratory pressure elevation, the cardiac index decreased by 13% +/- 9%. The right ventricular end-diastolic area, right atrial pressure, and pulmonary vascular resistance increased by 13% +/- 20%, 34% +/- 24% and 32% +/- 31%, respectively (p < .01; p = .04; and p < .01 vs. baseline, respectively). The transpulmonary pressure difference (mean pulmonary artery pressure--pulmonary artery occlusion pressure) increased (p < .05). Both at low and high positive end-expiratory pressure, an acute cor pulmonale was observed in the same three (14%) patients. At high positive end-expiratory pressure, the passive leg raising significantly increased the right and left ventricular end-diastolic areas and right atrial pressure. Passive leg raising also decreased the transpulmonary pressure difference (p < .05), increased the cardiac index by 14% +/- 10%, and decreased the pulmonary vascular resistance by 21% +/- 20% (both p < .01 vs. baseline)., Conclusions: In acute respiratory distress syndrome patients, a positive end-expiratory pressure increase with limited tidal volume and plateau pressure reduced cardiac output by increasing the right ventricular afterload. Passive leg raising restored cardiac output by reducing the transpulmonary pressure difference and the pulmonary vascular resistance. This suggests that some pulmonary microvessels were collapsed by positive end-expiratory pressure elevation and were recruited by increasing the central blood volume.
- Published
- 2010
- Full Text
- View/download PDF
15. Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients.
- Author
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Monnet X, Osman D, Ridel C, Lamia B, Richard C, and Teboul JL
- Subjects
- Humans, Positive-Pressure Respiration, Prospective Studies, Time Factors, Fluid Therapy, Hemodynamics, Intensive Care Units, Respiration, Artificial
- Abstract
Objective: During mechanical ventilation, inspiration cyclically decreases the left cardiac preload. Thus, an end-expiratory occlusion may prevent the cyclic impediment in left cardiac preload and may act like a fluid challenge. We tested whether this could serve as a functional test for fluid responsiveness in patients with circulatory failure., Design: Prospective study., Setting: Medical intensive care unit., Patients: Thirty-four mechanically ventilated patients with shock in whom volume expansion was planned., Intervention: A 15-second end-expiratory occlusion followed by a 500 mL saline infusion., Measurements: Arterial pressure and pulse contour-derived cardiac index (PiCCOplus) at baseline, during passive leg raising (PLR), during the 5-last seconds of the end-expiratory occlusion, and after volume expansion., Main Results: Volume expansion increased cardiac index by >15% (2.4 +/- 1.0 to 3.3 +/- 1.2 L/min/m, p < 0.05) in 23 patients ("responders"). Before volume expansion, the end-expiratory occlusion significantly increased arterial pulse pressure by 15% +/- 15% and cardiac index by 12% +/- 11% in responders whereas arterial pulse pressure and cardiac index did not change significantly in nonresponders. Fluid responsiveness was predicted by an increase in pulse pressure >or=5% during the end-expiratory occlusion with a sensitivity and a specificity of 87% and 100%, respectively, and by an increase in cardiac index >or=5% during the end-expiratory occlusion with a sensitivity and a specificity of 91% and 100%, respectively. The response of pulse pressure and cardiac index to the end-expiratory occlusion predicted fluid responsiveness with an accuracy that was similar to the response of cardiac index to PLR and that was significantly better than the response of pulse pressure to PLR (receiver operating characteristic curves area 0.957 [95% confidence interval [CI:] 0.825-0.994], 0.972 [95% CI: 0.849-0.995], 0.937 [95% CI: 0.797-0.990], and 0.675 [95% CI: 0.497-0.829], respectively)., Conclusions: The hemodynamic response to an end-expiratory occlusion can predict volume responsiveness in mechanically ventilated patients.
- Published
- 2009
- Full Text
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16. Champ 6. Sécurisation des procédures « circulatoires » (administration des substances vasoactives, utilisation des cathéters artériels, veineux centraux et artériels pulmonaires)
- Author
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J.-Y. Lefrant, J.-L. Teboul, and X. Monnet
- Subjects
Catheter insertion ,business.industry ,Continuous infusion ,medicine.medical_treatment ,Pulmonary artery catheter ,Hemodynamics ,General Medicine ,Balloon ,Anesthesiology and Pain Medicine ,Vasoactive ,Anesthesia ,medicine.artery ,Pulmonary artery ,Medicine ,business ,Arterial catheter insertion - Abstract
Arterial and central venous catheterizations and their use for continuous infusion of vasoactive drugs could lead to serious adverses events that could be life threatening. The incidence of human errors related patient adverses events could be decreased by the uses of algorithms and procedures. Concerning the continuous infusion of vasoactive drugs, the name of drug and its concentration should be clearly notified. The use of modern pump and noncompliant pipe could reduce the frequency bolus infusion and their related haemodynamic alterations. Reasonable procedure could reduce the arterial and central venous catheters related complications. Subclavian and radial sites should be preferred for central venous and arterial catheter insertion, respectively. The use of real time echographic guidance could facilitate the catheter insertion. These catheters should be removed when they are not indicated. Concerning the pulmonary artery catheter, the balloon tip should be inflated with visual control of the pulmonary artery pressure. Its removal is recommended within the first five days.
- Published
- 2008
17. Pulse pressure variation and ARDS
- Author
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J L, Teboul and X, Monnet
- Subjects
Respiratory Distress Syndrome ,Hemodynamics ,Fluid Therapy ,Humans ,Blood Pressure ,Stroke Volume ,Respiration, Artificial - Abstract
Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best fluid strategy. Arterial pulse pressure variation (PPV), which represents the amplitude of the respiratory changes in arterial pulse pressure, is considered as a marker of preload responsiveness in patients mechanically ventilated and fully adapted to their ventilator. The good ability of PPV to predict fluid responsiveness has been confirmed in various clinical situations (sepsis, operative and post-operative periods). However, there are a number of limits of using PPV (e.g., spontaneous breathing activity, cardiac arrhythmias, low tidal volume ventilation, low lung compliance), which are particularly important in ARDS. Clinical studies have confirmed the poor reliability of PPV in predicting fluid responsiveness in patients with ARDS, ventilated according to the currently recommended lung protective strategy. Although a PPV10-12% still keeps its good predictive value, a lower PPV (10%) is far to guarantee fluid unresponsiveness since many false-negative cases can be encountered in this setting. Thus, performance of alternative preload responsiveness tests such as passive leg raising or end-expiratory occlusion tests, is necessary when low PPV values are measured. This review addresses the meaning of PPV, its conditions of use and its limits in ARDS patients.
- Published
- 2013
18. Improvement in Hemodynamics by Activated Protein C in Septic Shock
- Author
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X. Monnet, H. Ksouri, and J. L. Teboul
- Subjects
Mean arterial pressure ,medicine.medical_specialty ,Surviving Sepsis Campaign ,Septic shock ,business.industry ,Hemodynamics ,medicine.disease ,Sepsis ,Internal medicine ,medicine ,business ,Survival rate ,Severe sepsis ,Protein C ,medicine.drug - Abstract
Recombinant human activated protein C (rhAPC) has been approved by the US Food and Drug Administration (FDA) for treating patients with sepsis or septic shock with an APACHE II score of more than 25 and by the European Agency for the Evaluation of Medicinal Products for multiple organ failure (MOF) related to sepsis. Furthermore, guidelines of the Surviving Sepsis Campaign recommend rhAPC as a standard-of-care for patients with severe sepsis and septic shock [1]. These approvals and recommendations were mainly supported by the results of the worldwide Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study [2], in which rhAPC was demonstrated to increase the survival rate of patients with the most severe forms of septic shock. This seminal study was focused on the overall mortality as the main criterion of judgement. Nevertheless in the following years, experimental and clinical studies suggested that rhAPC induces a specific improvement in the cardiovascular failure during septic shock. In this chapter, we will review these studies and the underlying mechanisms that are supposed to explain the effects of APC.
- Published
- 2009
19. Hemodynamic Management Guided by Esophageal Doppler
- Author
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J. L. Teboul and X. Monnet
- Subjects
medicine.medical_specialty ,Cardiac output ,business.industry ,Fluid responsiveness ,Hemodynamics ,Blood flow ,Esophageal doppler ,Pulse pressure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Aortic diameter ,business ,Surgical patients - Abstract
The esophageal Doppler technique has progressively emerged as a minimally invasive and reliable tool for measuring aortic blood flow and estimating cardiac output. Numerous studies have emphasized its clinical utility by showing improved outcome in surgical patients when hemodynamic therapy was driven by algorithms based on esophageal Doppler data. In the setting of the ICU, the ability of esophageal Doppler to track the changes in aortic blood flow in a beat-to-beat manner makes it particularly suitable for predicting fluid responsiveness, either by the measurement of the aortic blood flow respiratory variation or by testing the effects of passive leg raising.
- Published
- 2006
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