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2. Consistency of data reporting in fluid responsiveness studies in the critically ill setting: the CODEFIRE consensus from the Cardiovascular Dynamic section of the European Society of Intensive Care Medicine

Author

Messina, Antonio, Chew, Michelle S., Poole, Daniele, Calabrò, Lorenzo, De Backer, Daniel, Donadello, Katia, Hernandez, Glenn, Hamzaoui, Olfa, Jozwiak, Mathieu, Lai, Christopher, Malbrain, Manu L. N. G., Mallat, Jihad, Myatra, Sheyla Nainan, Muller, Laurent, Ospina-Tascon, Gustavo, Pinsky, Michael R., Preau, Sebastian, Saugel, Bernd, Teboul, Jean-Louis, Cecconi, Maurizio, and Monnet, Xavier

Published
2024
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5. Direct assessment of microcirculation in shock: a randomized-controlled multicenter study

Author

Bruno, Raphael Romano, Wollborn, Jakob, Fengler, Karl, Flick, Moritz, Wunder, Christian, Allgäuer, Sebastian, Thiele, Holger, Schemmelmann, Mara, Hornemann, Johanna, Moecke, Helene Mathilde Emilie, Demirtas, Filiz, Palici, Lina, Franz, Marcus, Saugel, Bernd, Kattan, Eduardo, De Backer, Daniel, Bakker, Jan, Hernandez, Glenn, Kelm, Malte, and Jung, Christian

Published
2023
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8. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Author

Reyes, Luis Felipe, Rodriguez, Alejandro, Fuentes, Yuli V., Duque, Sara, García-Gallo, Esteban, Bastidas, Alirio, Serrano-Mayorga, Cristian C., Ibáñez-Prada, Elsa D., Moreno, Gerard, Ramirez-Valbuena, Paula C., Ospina-Tascon, Gustavo, Hernandez, Glenn, Silva, Edwin, Díaz, Ana Maria, Jibaja, Manuel, Vera-Alarcon, Magdalena, Díaz, Emili, Bodí, María, Solé-Violán, Jordi, Ferrer, Ricard, Albaya-Moreno, Antonio, Socias, Lorenzo, Figueroa, William, Lozano-Villanueva, Jose L., Varón-Vega, Fabio, Estella, Ángel, Loza-Vazquez, Ana, Jorge-García, Ruth, Sancho, Isabel, Shankar-Hari, Manu, and Martin-Loeches, Ignacio

Published
2023
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9. The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update?

Author

Moreno, Rui, Rhodes, Andrew, Piquilloud, Lise, Hernandez, Glenn, Takala, Jukka, Gershengorn, Hayley B., Tavares, Miguel, Coopersmith, Craig M., Myatra, Sheila N., Singer, Mervyn, Rezende, Ederlon, Prescott, Hallie C., Soares, Márcio, Timsit, Jean-François, de Lange, Dylan W., Jung, Christian, De Waele, Jan J., Martin, Greg S., Summers, Charlotte, Azoulay, Elie, Fujii, Tomoko, McLean, Anthony S., and Vincent, Jean-Louis

Published
2023
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14. How can assessing hemodynamics help to assess volume status?

Author

De Backer, Daniel, Aissaoui, Nadia, Cecconi, Maurizio, Chew, Michelle S., Denault, André, Hajjar, Ludhmila, and Hernandez, Glenn

Subjects
Venous pressure, Health care industry
Abstract

In critically ill patients, fluid infusion is aimed at increasing cardiac output and tissue perfusion. However, it may contribute to fluid overload which may be harmful. Thus, volume status, risks and potential efficacy of fluid administration and/or removal should be carefully evaluated, and monitoring techniques help for this purpose. Central venous pressure is a marker of right ventricular preload. Very low values indicate hypovolemia, while extremely high values suggest fluid harmfulness. The pulmonary artery catheter enables a comprehensive assessment of the hemodynamic profile and is particularly useful for indicating the risk of pulmonary oedema through the pulmonary artery occlusion pressure. Besides cardiac output and preload, transpulmonary thermodilution measures extravascular lung water, which reflects the extent of lung flooding and assesses the risk of fluid infusion. Echocardiography estimates the volume status through intravascular volumes and pressures. Finally, lung ultrasound estimates lung edema. Guided by these variables, the decision to infuse fluid should first consider specific triggers, such as signs of tissue hypoperfusion. Second, benefits and risks of fluid infusion should be weighted. Thereafter, fluid responsiveness should be assessed. Monitoring techniques help for this purpose, especially by providing real time and precise measurements of cardiac output. When decided, fluid resuscitation should be performed through fluid challenges, the effects of which should be assessed through critical endpoints including cardiac output. This comprehensive evaluation of the risk, benefits and efficacy of fluid infusion helps to individualize fluid management, which should be preferred over a fixed restrictive or liberal strategy., Author(s): Daniel De Backer [sup.1], Nadia Aissaoui [sup.2], Maurizio Cecconi [sup.3] [sup.4], Michelle S. Chew [sup.5], André Denault [sup.6] [sup.7], Ludhmila Hajjar [sup.8], Glenn Hernandez [sup.9], Antonio Messina [sup.3] [sup.4], [...]

Published
2022
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15. Correction: Direct assessment of microcirculation in shock: a randomized-controlled multicenter study

Author

Bruno, Raphael Romano, Wollborn, Jakob, Fengler, Karl, Flick, Moritz, Wunder, Christian, Allgäuer, Sebastian, Thiele, Holger, Schemmelmann, Mara, Hornemann, Johanna, Moecke, Helene Mathilde Emilie, Demirtas, Filiz, Palici, Lina, Franz, Marcus, Saugel, Bernd, Kattan, Eduardo, De Backer, Daniel, Bakker, Jan, Hernandez, Glenn, Kelm, Malte, and Jung, Christian

Published
2023
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16. Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients

Author

Valenzuela, Emilio Daniel, Mercado, Pablo, Pairumani, Ronald, Medel, Juan Nicolás, Petruska, Edward, Ugalde, Diego, Morales, Felipe, Eisen, Daniela, Araya, Carla, Montoya, Jorge, Gonzalez, Alejandra, Rovegno, Maximiliano, Ramirez, Javier, Aguilera, Javiera, Hernández, Glenn, Bruhn, Alejandro, Slama, Michel, and Bakker, Jan

Published
2022
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20. Dexamethasone as risk-factor for ICU-acquired respiratory tract infections in severe COVID-19

Author

Reyes, Luis Felipe, Rodriguez, Alejandro, Bastidas, Alirio, Parra-Tanoux, Daniela, Fuentes, Yuli V., García-Gallo, Esteban, Moreno, Gerard, Ospina-Tascon, Gustavo, Hernandez, Glenn, Silva, Edwin, Díaz, Ana Maria, Jibaja, Manuel, Vera, Magdalena, Díaz, Emilio, Bodí, María, Solé-Violán, Jordi, Ferrer, Ricard, Albaya-Moreno, Antonio, Socias, Lorenzo, Estella, Ángel, Loza-Vazquez, Ana, Jorge-García, Ruth, Sancho, Isabel, and Martin-Loeches, Ignacio

Published
2022
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23. Current practice and evolving concepts in septic shock resuscitation

Author

Bakker, Jan, Kattan, Eduardo, Annane, Djillali, Castro, Ricardo, Cecconi, Maurizio, De Backer, Daniel, Dubin, Arnaldo, Evans, Laura, Gong, Michelle Ng, Hamzaoui, Olfa, Ince, Can, Levy, Bruno, Monnet, Xavier, Ospina Tascón, Gustavo A., Ostermann, Marlies, Pinsky, Michael R., Russell, James A., Saugel, Bernd, Scheeren, Thomas W. L., Teboul, Jean-Louis, Vieillard Baron, Antoine, Vincent, Jean-Louis, Zampieri, Fernando G., and Hernandez, Glenn

Published
2022
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26. Effective hemodynamic monitoring

Author

Pinsky, Michael R., Cecconi, Maurizio, Chew, Michelle S., De Backer, Daniel, Douglas, Ivor, Edwards, Mark, Hamzaoui, Olfa, Hernandez, Glenn, Martin, Greg, Monnet, Xavier, Saugel, Bernd, Scheeren, Thomas W. L., Teboul, Jean-Louis, and Vincent, Jean-Louis

Published
2022
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28. The Netherlands

Author

Aguilar-Hernandez, Glenn A., primary, Rodrigues, João F. D., additional, and Tukker, Arnold, additional

Published
2022
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30. Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery

Author

Castro, Ricardo, Born, Pablo, Muñoz, Felipe, Guzmán, Camila, Kattan, Eduardo, Hernandez, Glenn, Bakker, Jan, Castro, Ricardo, Born, Pablo, Muñoz, Felipe, Guzmán, Camila, Kattan, Eduardo, Hernandez, Glenn, and Bakker, Jan

Abstract

A positive fluid balance may evolve to fluid overload and associate with organ dysfunctions, weaning difficulties, and increased mortality in ICU patients. We explored whether individualized fluid management, assessing fluid responsiveness via a passive leg-raising maneuver (PLR) before a spontaneous breathing trial (SBT), is associated with less extubation failure in ventilated patients with a high fluid balance admitted to the ICU after liver transplantation (LT). We recruited 15 LT patients in 2023. Their postoperative fluid balance was +4476 {3697, 5722} mL. PLR maneuvers were conducted upon ICU admission (T1) and pre SBT (T2). Cardiac index (CI) changes were recorded before and after each SBT (T3). Seven patients were fluid-responsive at T1, and twelve were responsive at T2. No significant differences occurred in hemodynamic, respiratory, and perfusion parameters between the fluid-responsive and fluid-unresponsive patients at any time. Fluid-responsive patients at T1 and T2 increased their CI during SBT from 3.1 {2.8, 3.7} to 3.7 {3.4, 4.1} mL/min/m2 (p = 0.045). All fluid-responsive patients at T2 were extubated after the SBTs and consolidated extubation. Two out of three of the fluid-unresponsive patients experienced weaning difficulties. We concluded that fluid-responsive patients post LT may start weaning earlier and achieve successful extubation despite a high postoperative fluid balance. This highlights the profound impact of personalized assessments of cardiovascular state on critical surgical patients.

Published
2024

31. Lactate

Author

Castro, Ricardo, Carpio, David, Hernández, Glenn, Cecconi, Maurizio, Series Editor, De Backer, Daniel, Series Editor, Pinsky, Michael R., editor, Teboul, Jean-Louis, editor, and Vincent, Jean-Louis, editor

Published
2019
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36. Equilibrating SSC guidelines with individualized care

Author

Vincent, Jean-Louis, Singer, Mervyn, Einav, Sharon, Moreno, Rui, Wendon, Julia, Teboul, Jean-Louis, Bakker, Jan, Hernandez, Glenn, Annane, Djillali, de Man, Angélique M. E., Monnet, Xavier, Ranieri, V. Marco, Hamzaoui, Olfa, Takala, Jukka, Juffermans, Nicole, Chiche, Jean-Daniel, Myatra, Sheila N., and De Backer, Daniel

Published
2021
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38. Current use of inotropes in circulatory shock

Author

Scheeren, Thomas W. L., Bakker, Jan, Kaufmann, Thomas, Annane, Djillali, Asfar, Pierre, Boerma, E. Christiaan, Cecconi, Maurizio, Chew, Michelle S., Cholley, Bernard, Cronhjort, Maria, De Backer, Daniel, Dubin, Arnaldo, Dünser, Martin W., Duranteau, Jacques, Gordon, Anthony C., Hajjar, Ludhmila A., Hamzaoui, Olfa, Hernandez, Glenn, Kanoore Edul, Vanina, Koster, Geert, Landoni, Giovanni, Leone, Marc, Levy, Bruno, Martin, Claude, Mebazaa, Alexandre, Monnet, Xavier, Morelli, Andrea, Payen, Didier, Pearse, Rupert M., Pinsky, Michael R., Radermacher, Peter, Reuter, Daniel A., Sakr, Yasser, Sander, Michael, Saugel, Bernd, Singer, Mervyn, Squara, Pierre, Vieillard-Baron, Antoine, Vignon, Philippe, Vincent, Jean-Louis, van der Horst, Iwan C. C., Vistisen, Simon T., and Teboul, Jean-Louis

Published
2021
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40. The ten pitfalls of lactate clearance in sepsis

Author

Hernandez, Glenn, Bellomo, Rinaldo, and Bakker, Jan

Subjects
Medicine, Preventive, Medical colleges, Preventive health services, Health care industry
Abstract

Author(s): Glenn Hernandez [sup.1], Rinaldo Bellomo [sup.2] [sup.3] [sup.4] [sup.5], Jan Bakker [sup.1] [sup.6] [sup.7] [sup.8] Author Affiliations: (1) 0000 0001 2157 0406, grid.7870.8, Departamento de Medicina Intensiva, Facultad de [...]

Published
2019
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41. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force

Author

Cecconi, Maurizio, Hernandez, Glenn, Dunser, Martin, Antonelli, Massimo, Baker, Tim, Bakker, Jan, and Duranteau, Jacques

Subjects
Task forces, Evidence, Expert, Shock, Medical colleges, Health care industry
Abstract

An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide., Author(s): Maurizio Cecconi [sup.1] [sup.2], Glenn Hernandez [sup.3], Martin Dunser [sup.4], Massimo Antonelli [sup.5], Tim Baker [sup.6] [sup.7], Jan Bakker [sup.3] [sup.8] [sup.9] [sup.10] [sup.11], Jacques Duranteau [sup.12] [sup.13], Sharon [...]

Published
2019
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42. Doppler identified venous congestion in septic shock: protocol for an international, multi-centre prospective cohort study (Andromeda-VEXUS)

Author

Prager, Ross, primary, Argaiz, Eduardo, additional, Pratte, Michael, additional, Rola, Philippe, additional, Arntfield, Robert, additional, Beaubien-Souligny, William, additional, Denault, André Y, additional, Haycock, Korbin, additional, Miralles Aguiar, Francisco, additional, Bakker, Jan, additional, Ospina-Tascon, Gustavo, additional, Orozco, Nicolas, additional, Rochwerg, Bram, additional, Lewis, Kimberley, additional, Quazi, Ibrahim, additional, Kattan, Eduardo, additional, Hernandez, Glenn, additional, and Basmaji, John, additional

Published
2023
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48. Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine

Author

Ince, Can, Boerma, E. Christiaan, Cecconi, Maurizio, De Backer, Daniel, Shapiro, Nathan I., Duranteau, Jacques, Pinsky, Michael R., Artigas, Antonio, Teboul, Jean-Louis, Reiss, Irwin K. M., Aldecoa, Cesar, Hutchings, Sam D., Donati, Abele, Maggiorini, Marco, Taccone, Fabio S., Hernandez, Glenn, Payen, Didier, Tibboel, Dick, Martin, Daniel S., Zarbock, Alexander, Monnet, Xavier, Dubin, Arnaldo, Bakker, Jan, Vincent, Jean-Louis, Scheeren, Thomas W. L., and On behalf of the Cardiovascular Dynamics Section of the ESICM

Published
2018
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49. Doppler identified venous congestion in septic shock:protocol for an international, multi-centre prospective cohort study (Andromeda-VEXUS)

Author

Prager, Ross, Argaiz, Eduardo, Pratte, Michael, Rola, Philippe, Arntfield, Robert, Beaubien-Souligny, William, Denault, André Y., Haycock, Korbin, Miralles Aguiar, Francisco, Bakker, Jan, Ospina-Tascon, Gustavo, Orozco, Nicolas, Rochwerg, Bram, Lewis, Kimberley, Quazi, Ibrahim, Kattan, Eduardo, Hernandez, Glenn, Basmaji, John, Prager, Ross, Argaiz, Eduardo, Pratte, Michael, Rola, Philippe, Arntfield, Robert, Beaubien-Souligny, William, Denault, André Y., Haycock, Korbin, Miralles Aguiar, Francisco, Bakker, Jan, Ospina-Tascon, Gustavo, Orozco, Nicolas, Rochwerg, Bram, Lewis, Kimberley, Quazi, Ibrahim, Kattan, Eduardo, Hernandez, Glenn, and Basmaji, John

Abstract

INTRODUCTION: Venous congestion is a pathophysiological state where high venous pressures cause organ oedema and dysfunction. Venous congestion is associated with worse outcomes, particularly acute kidney injury (AKI), for critically ill patients. Venous congestion can be measured by Doppler ultrasound at the bedside through interrogation of the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV) and intrarenal veins (IRV). The objective of this study is to quantify the association between Doppler identified venous congestion and the need for renal replacement therapy (RRT) or death for patients with septic shock. METHODS AND ANALYSIS: This study is a prespecified substudy of the ANDROMEDA-SHOCK 2 (AS-2) randomised control trial (RCT) assessing haemodynamic resuscitation in septic shock and will enrol at least 350 patients across multiple sites. We will include adult patients within 4 hours of fulfilling septic shock definition according to Sepsis-3 consensus conference. Using Doppler ultrasound, physicians will interrogate the IVC, HV, PV and IRV 6-12 hours after randomisation. Study investigators will provide web-based educational sessions to ultrasound operators and adjudicate image acquisition and interpretation. The primary outcome will be RRT or death within 28 days of septic shock. We will assess the hazard of RRT or death as a function of venous congestion using a Cox proportional hazards model. Sub-distribution HRs will describe the hazard of RRT given the competing risk of death. ETHICS AND DISSEMINATION: We obtained ethics approval for the AS-2 RCT, including this observational substudy, from local ethics boards at all participating sites. We will report the findings of this study through open-access publication, presentation at international conferences, a coordinated dissemination strategy by investigators through social media, and an open-access workshop series in multiple languages. TRIAL REGISTRATION NUMBER: NCT05057611.

Published
2023

50. Direct assessment of microcirculation in shock:a randomized-controlled multicenter study

Author

Bruno, Raphael Romano, Wollborn, Jakob, Fengler, Karl, Flick, Moritz, Wunder, Christian, Allgäuer, Sebastian, Thiele, Holger, Schemmelmann, Mara, Hornemann, Johanna, Moecke, Helene Mathilde Emilie, Demirtas, Filiz, Palici, Lina, Franz, Marcus, Saugel, Bernd, Kattan, Eduardo, De Backer, Daniel, Bakker, Jan, Hernandez, Glenn, Kelm, Malte, Jung, Christian, Bruno, Raphael Romano, Wollborn, Jakob, Fengler, Karl, Flick, Moritz, Wunder, Christian, Allgäuer, Sebastian, Thiele, Holger, Schemmelmann, Mara, Hornemann, Johanna, Moecke, Helene Mathilde Emilie, Demirtas, Filiz, Palici, Lina, Franz, Marcus, Saugel, Bernd, Kattan, Eduardo, De Backer, Daniel, Bakker, Jan, Hernandez, Glenn, Kelm, Malte, and Jung, Christian

Abstract

Purpose: Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock. Methods: This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock. All patients received sequential sublingual measurements using a sidestream-dark field (SDF) video microscope at admission to the intensive care unit (± 4 h) and 24 (± 4) hours later that was performed blindly to the treatment team. Patients were randomized to usual routine or to integrating sublingual microcirculatory perfusion variables in the therapy plan. The primary endpoint was 30-day mortality, secondary endpoints were length of stay on the ICU and the hospital, and 6-months mortality. Results: Overall, we included 141 patients with cardiogenic (n = 77), post cardiac surgery (n = 27), or septic shock (n = 22). 69 patients were randomized to the intervention and 72 to routine care. No serious adverse events (SAEs) occurred. In the interventional group, significantly more patients received an adjustment (increase or decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%, p = 0.009) within the next hour. Microcirculatory values 24 h after admission and 30-day mortality did not differ [crude: 32 (47.1%) patients versus 25 (34.7%), relative risk (RR) 1.39 (0.91–1.97); Cox-regression: hazard ratio (HR) 1.54 (95% confidence interval (CI) 0.90–2.66, p = 0.118)]. Conclusion: Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all. Graphical Abstract: [Figure not available: see fulltext.]

Published
2023

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