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Byline: Caroline Etchecopar-Chevreuil (1,2), Bruno Francois (1,3), Marc Clavel (1,3), Nicolas Pichon (1,3), Herve Gastinne (1,2), Philippe Vignon (1,2,3,4) Keywords: Sepsis; Shock; Echocardiography; Doppler Abstract: Objective The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. Design Prospective, observational study. Setting Medical-surgical intensive care unit of a teaching hospital. Patients and participants Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12a-h of admission (Daya-0), after stabilization of hemodynamics by fluid loading (median volume: 4.9a-l [lower and upper quartiles: 3.7--9.6a-l]) and vasopressor therapy, and after vasopressors were stopped (Daya-n). Measurements and results Thirty-five patients were studied (median age: 60 years [range 44--68] SAPS II: 53 [46--62] SOFA score: 9 [8--11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Daya-0 and Daya-n (7 days [range 6--9]), mean left ventricular (LV) ejection fraction (EF) increased (47a-+-a-20 vs. 57a-+-a-14%: pa- Conclusions This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. Descriptors Shock: clinical studies (38), Cardiovascular monitoring (34). Author Affiliation: (1) Medical-Surgical Intensive Care Unit, Dupuytren Teaching Hospital, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France (2) University of Limoges, Limoges, France (3) Centrede Recherche Clinique, Dupuytren Teaching Hospital, Limoges, France (4) Reanimation Polyvalente, CHU Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France Article History: Registration Date: 17/10/2007 Received Date: 27/03/2007 Accepted Date: 15/10/2007 Online Date: 15/11/2007

Byline: Philippe Vignon (1,2), Anthony Dugard (1,2), Julie Abraham (1), Dominique Belcour (1), Guillaume Gondran (1), Frederic Pepino (1), Benoit Marin (4), Bruno Francois (1,2), Herve Gastinne (1,3) Keywords: Transthoracic echocardiography; Two-dimensional echocardiography; Curriculum; Intensive care Abstract: Objective We sought to evaluate the efficacy of a limited training dedicated to residents without knowledge in ultrasound for performing goal-oriented echocardiography in ICU patients. Design Prospective pilot observational study. Setting Medical-surgical ICU of a teaching hospital. Patients 61 consecutive adult ICU patients (SAPSa-II score: 38a-+-a-17 46 ventilated patients) requiring a transthoracic echocardiography were studied. Interventions After a curriculum including a 3-h training course and 5a-h of hands-on training, one of four noncardiologist residents and an intensivist experienced in ultrasound subsequently performed hand-held echocardiography (HHE), independently and in random order. Assessable 'rule in, rule out' clinical questions were purposely limited to easily identifiable conditions by the sole use of two-dimensional imaging. Measurements and results When compared with residents, the experienced intensivist performed shorter examinations (4a-+-a-1 vs. 11a-+-a-4a-min: pa- Conclusions Limited training of noncardiologist ICU residents without previous knowledge in ultrasound appears feasible and efficient to address simple clinical questions using point-of-care echography. Influence of the learning curve on diagnostic accuracy and potential therapeutic impact remain to be determined. Author Affiliation: (1) Medical-Surgical Intensive Care Unit, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France (2) Centre de Recherche Clinique, CHU Limoges, Limoges, France (3) University of Limoges, Limoges, France (4) Unit of Clinical Research and Biostatistics, Dupuytren Teaching Hospital, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France Article History: Registration Date: 22/05/2007 Received Date: 13/03/2007 Accepted Date: 16/05/2007 Online Date: 16/06/2007

Abstract Objective: Colonization of multiple body sites is a leading risk factor for Candida spp. infection in intensive care unit (ICU) patients. We evaluated whether oral nystatin prophylaxis reduces Candida [...]

Byline: Philippe Vignon (1), MickaA< Keywords: Critical care; Echocardiography; Echocardiography Doppler; Diagnostic techniques and procedures Abstract: Objective To evaluate the diagnostic capability of a hand-carried ultrasound device (HCU) in critically ill patients when using conventional transthoracic echocardiography (TTE) as a reference. Design Prospective, descriptive study. Setting Medical-surgical intensive care unit of a teaching hospital. Patients All patients requiring a TTE study were eligible. Interventions Each patient underwent an echocardiographic examination using a full-feature echocardiographic platform (Sonos 5500, Philips Medical Systems, Andover, MA) and a small battery-operated device (SonoHeart Elite, SonoSite, Bothell, WA). The operators (level III training in echocardiography) were randomized (HCU vs. TTE) and they independently interpreted the echocardiograms at the patient bedside. Results During a 2-month period, 55 consecutive patients (age: 61+-16 years, simplified acute physiology score 46+-15, body mass index 26+-7) were studied, 40 of them being mechanically ventilated (73%). The number of acoustic windows was comparable using HCU and TTE (2.3+-0.8 vs. 2.4+-0.8: P=0.24). The overall diagnostic accuracy of HCU was lower compared with conventional TTE (137/171 vs. 158/171 clinical questions solved: P=0.002), reaching 80% and 92%, respectively. Despite its spectral Doppler capability, HCU missed diagnoses that were adequately identified by TTE: elevated left ventricular pressure (n=2), relevant valvulopathy (n=2) and moderate (n=4) or severe (n=2) pulmonary hypertension. Acute management was altered by HCU and TTE findings in 27 patients (49%) and 28 patients (51%), respectively. Conclusions In this study, HCU had a lower diagnostic accuracy compared with conventional TTE, despite its spectral Doppler capability. Further studies are needed to validate these evolving diagnostic tools in critical care settings. Author Affiliation: (1) Service de Reanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France (2) Cardiology Department, Dupuytren Teaching Hospital, Limoges, France Article History: Registration Date: 05/12/2003 Received Date: 22/08/2003 Accepted Date: 01/12/2003 Online Date: 13/01/2004