Abstract:
OBJECTIVES:To assess whether, in patients under mechanical ventilation, fluid responsiveness is predicted by the effects of short respiratory holds on cardiac index estimated by esophageal Doppler. DESIGN:Prospective, monocentric study. SETTING:Medical ICU. PATIENTS:Twenty-eight adult patients with acute circulatory failure and a decision of the clinicians in charge to administer fluids. INTERVENTIONS:Before and after infusing 500 mL of saline, we measured cardiac index estimated by esophageal Doppler before and during the last 5 seconds of successive 15-second end-inspiratory occlusion and end-expiratory occlusion, separated by 1 minute. Patients in whom volume expansion increased cardiac index measured by transpulmonary thermodilution greater than or equal to 15% were defined as "fluid responders." Cardiac index measured by the Pulse Contour Cardiac Output device (from pulse contour analysis or transpulmonary thermodilution) was used as the reference. MEASUREMENTS AND MAIN RESULTS:End-expiratory occlusion increased cardiac index estimated by esophageal Doppler more in responders than in nonresponders (8% ± 2% vs 3% ± 1%, respectively; p < 0.0001) and end-inspiratory occlusion decreased cardiac index estimated by esophageal Doppler more in responders than in nonresponders (-8% ± 5% vs -4% ± 2%, respectively; p = 0.0002). Fluid responsiveness was predicted by the end-expiratory occlusion induced percent change in cardiac index estimated by esophageal Doppler with an area under the receiver operating characteristic curve of 1.00 (95% CI, 0.88-1.00) and a threshold value of 4% increase in cardiac index estimated by esophageal Doppler. It was predicted by the sum of absolute values of percent changes in cardiac index estimated by esophageal Doppler during both occlusions with a similar area under the receiver operating characteristic curve (0.99 [0.86-1.00]) and with a threshold of 9% change in cardiac index estimated by esophageal Doppler, which is compatible with the esophageal Doppler precision. CONCLUSIONS:If the absolute sum of the percent change in cardiac index estimated by esophageal Doppler induced by two successive end-inspiratory occlusion and end-expiratory occlusion maneuvers is greater than 9%, it is likely that a 500 mL fluid infusion will increase cardiac output. This diagnostic threshold is higher than if only end-expiratory occlusion induced percent changes in cardiac index estimated by esophageal Doppler are taken into account.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Dépret F,Jozwiak M,Teboul JL,Alphonsine JE,Richard C,Monnet Xdoi
10.1097/CCM.0000000000003522subject
Has Abstractpub_date
2019-02-01 00:00:00pages
e96-e102issue
2eissn
0090-3493issn
1530-0293journal_volume
47pub_type
杂志文章abstract:OBJECTIVES:A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002872
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of increasing the preoxygenation period with 100% oxygen in the critically ill patient from 4 to 8 mins in preparation for emergency tracheal intubation. DESIGN:Nonrandomized, controlled trial. SETTING:Large, level one trauma center, tertiary care intensive care unit. PATIENT...
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pub_type: 杂志文章,多中心研究
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更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients. DESIGN:Prospective, open-label, observational, cohort stud...
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doi:10.1097/CCM.0000000000001188
更新日期:2015-11-01 00:00:00
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更新日期:2011-11-01 00:00:00
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doi:10.1097/01.ccm.0000166349.76514.40
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doi:10.1097/01.ccm.0000132898.27101.6c
更新日期:2004-08-01 00:00:00
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doi:10.1097/CCM.0b013e3182772ab6
更新日期:2013-01-01 00:00:00
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pub_type: 评论,杂志文章
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更新日期:2005-02-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2020-01-01 00:00:00
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更新日期:2010-10-01 00:00:00
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doi:
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更新日期:2012-12-01 00:00:00
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更新日期:2000-04-01 00:00:00
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doi:10.1097/CCM.0000000000004222
更新日期:2020-05-01 00:00:00
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doi:10.1097/00003246-198108000-00004
更新日期:1981-08-01 00:00:00
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doi:10.1097/00003246-198511000-00012
更新日期:1985-11-01 00:00:00
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doi:
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更新日期:1998-04-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181fb7b5f
更新日期:2011-01-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1097/00003246-198611000-00013
更新日期:1986-11-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/CCM.0000000000004515
更新日期:2020-10-01 00:00:00