-
Original Article05-07-2025
Pulmonary artery pressure assessed by catheterization and its concordance with transthoracic echocardiographic estimates in patients with pulmonary arterial hypertension: experience of the Colombian Pulmonary Hypertension Network in a real-life study
- Mauricio Orozco-Levi
, - Alejandro Londoño ,
- Rafael Conde ,
- Manuel Conrado Pacheco Gallego ,
- Julián Cortes Colorado , [ ... ],
- Alba Ramírez-Sarmiento
Abstract
Original ArticlePulmonary artery pressure assessed by catheterization and its concordance with transthoracic echocardiographic estimates in patients with pulmonary arterial hypertension: experience of the Colombian Pulmonary Hypertension Network in a real-life study
Critical Care Science. 2025;37:e20250182
DOI 10.62675/2965-2774.20250182
- Mauricio Orozco-Levi ,
- Alejandro Londoño ,
- Rafael Conde ,
- Manuel Conrado Pacheco Gallego ,
- Julián Cortes Colorado ,
- Carlos Jaime Velázquez ,
- Ricardo Gómez Palau ,
- Lucila Teresa Flórez de Arco ,
- Juliana De Luque ,
- Ana Maria Pérez-Zauner ,
- Alba Ramírez-Sarmiento
Views167ABSTRACT
Objective
To evaluate the correlation and concordance of pulmonary artery systolic pressure values measured via right heart catheterization and estimated via transthoracic echocardiography based on data from a multicenter cohort of patients with pulmonary hypertension in Colombia.
Methods
A retrospective study was conducted of patients with pulmonary hypertension classified into Groups 1 or 4 according to the definitions of the ESC/ERS-PH-2022 guidelines. Patients were obtained from the Colombian Pulmonary Hypertension Network (HAPredco) database.
Results
A total of 633 patients were identified and included in this study. Among these patients, 77.7% (n = 492) had complete data from transthoracic echocardiography at diagnosis, 58,3% (n = 369) had complete data from right heart catheterization at the time of diagnosis, and 264 (41.7%) had complete data from both tests at diagnosis, with a difference in days between them of 1 (84). The values of pulmonary artery systolic pressure estimated by transthoracic echocardiography and those obtained by right heart catheterization were significantly correlated (p < 0.001) in the entire population evaluated, as was the correlation assessed for those patients with a gap of ≤ 7 days (p = 0.0001) or ≤ 48 hours (p = 0.041) between the two examinations; however, these findings presented a low Spearman (0.32 for ≤ 7 days and 0.264 for ≤ 48 hours) and Lin´s correlation coefficient (0.32 for ≤ 7 days and 0.21 for ≤ 48 hours).
Conclusion
The pulmonary artery systolic pressure values estimated via transthoracic echocardiography and measured via right heart catheterization were significantly but weakly linearly correlated, with low concordance. These findings suggest interindividual variability between the pulmonary artery systolic pressure values obtained by the two methods, which may have clinical significance in follow-up and decision-making.
Keywords:Blood pressureCardiac catheterizationEchocardiographyPulmonary arterial hypertensionPulmonary arterySee moreViews167
Abstract
Original ArticlePulmonary artery pressure assessed by catheterization and its concordance with transthoracic echocardiographic estimates in patients with pulmonary arterial hypertension: experience of the Colombian Pulmonary Hypertension Network in a real-life study
Critical Care Science. 2025;37:e20250182
DOI 10.62675/2965-2774.20250182
- Mauricio Orozco-Levi ,
- Alejandro Londoño ,
- Rafael Conde ,
- Manuel Conrado Pacheco Gallego ,
- Julián Cortes Colorado ,
- Carlos Jaime Velázquez ,
- Ricardo Gómez Palau ,
- Lucila Teresa Flórez de Arco ,
- Juliana De Luque ,
- Ana Maria Pérez-Zauner ,
- Alba Ramírez-Sarmiento
Views167ABSTRACT
Objective
To evaluate the correlation and concordance of pulmonary artery systolic pressure values measured via right heart catheterization and estimated via transthoracic echocardiography based on data from a multicenter cohort of patients with pulmonary hypertension in Colombia.
Methods
A retrospective study was conducted of patients with pulmonary hypertension classified into Groups 1 or 4 according to the definitions of the ESC/ERS-PH-2022 guidelines. Patients were obtained from the Colombian Pulmonary Hypertension Network (HAPredco) database.
Results
A total of 633 patients were identified and included in this study. Among these patients, 77.7% (n = 492) had complete data from transthoracic echocardiography at diagnosis, 58,3% (n = 369) had complete data from right heart catheterization at the time of diagnosis, and 264 (41.7%) had complete data from both tests at diagnosis, with a difference in days between them of 1 (84). The values of pulmonary artery systolic pressure estimated by transthoracic echocardiography and those obtained by right heart catheterization were significantly correlated (p < 0.001) in the entire population evaluated, as was the correlation assessed for those patients with a gap of ≤ 7 days (p = 0.0001) or ≤ 48 hours (p = 0.041) between the two examinations; however, these findings presented a low Spearman (0.32 for ≤ 7 days and 0.264 for ≤ 48 hours) and Lin´s correlation coefficient (0.32 for ≤ 7 days and 0.21 for ≤ 48 hours).
Conclusion
The pulmonary artery systolic pressure values estimated via transthoracic echocardiography and measured via right heart catheterization were significantly but weakly linearly correlated, with low concordance. These findings suggest interindividual variability between the pulmonary artery systolic pressure values obtained by the two methods, which may have clinical significance in follow-up and decision-making.
Keywords:Blood pressureCardiac catheterizationEchocardiographyPulmonary arterial hypertensionPulmonary arterySee more
- Mauricio Orozco-Levi
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Special Article08-07-2023
The use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John , [ ... ],
- Ricardo Luiz Cordioli
Abstract
Special ArticleThe use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Critical Care Science. 2023;35(2):117-146
DOI 10.5935/2965-2774.20230310-en
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John ,
- Ana Cláudia Tonelli de Oliveira ,
- Alexandre Jorge de Andrade Negri,
- Ana Burigo Grumann ,
- Dalton de Souza Barros,
- Fátima Elizabeth Fonseca de Oliveira Negri,
- Gérson Luiz de Macedo ,
- Júlio Leal Bandeira Neves,
- Márcio da Silveira Rodrigues,
- Marcio Fernando Spagnól ,
- Marcus Antonio Ferez,
- Ricardo Ávila Chalhub ,
- Ricardo Luiz Cordioli
Views66ABSTRACT
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
Keywords:critical illnessEchocardiographyHemodynamicsShockSurveys and questionnairesVentricular function, leftVentricular function, rightSee moreViews66Abstract
Special ArticleThe use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Critical Care Science. 2023;35(2):117-146
DOI 10.5935/2965-2774.20230310-en
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John ,
- Ana Cláudia Tonelli de Oliveira ,
- Alexandre Jorge de Andrade Negri,
- Ana Burigo Grumann ,
- Dalton de Souza Barros,
- Fátima Elizabeth Fonseca de Oliveira Negri,
- Gérson Luiz de Macedo ,
- Júlio Leal Bandeira Neves,
- Márcio da Silveira Rodrigues,
- Marcio Fernando Spagnól ,
- Marcus Antonio Ferez,
- Ricardo Ávila Chalhub ,
- Ricardo Luiz Cordioli
Views66ABSTRACT
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
Keywords:critical illnessEchocardiographyHemodynamicsShockSurveys and questionnairesVentricular function, leftVentricular function, rightSee more
- José Augusto Santos Pellegrini
-
Original Article08-07-2023
The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients
- Timor Omar ,
- Kamil İnci ,
- Yusuf Oflu ,
- Mustafa Dilek ,
- Zeynep Binici Çelik , [ ... ],
- Halil Murat Bucak
Abstract
Original ArticleThe predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients
Critical Care Science. 2023;35(2):187-195
DOI 10.5935/2965-2774.20230378-en
- Timor Omar ,
- Kamil İnci ,
- Yusuf Oflu ,
- Mustafa Dilek ,
- Zeynep Binici Çelik ,
- Soner Kına ,
- Doğan İliş ,
- Halil Murat Bucak
Views103ABSTRACT
Objective:
Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients.
Methods:
This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission.
Results:
One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores.
Conclusion:
Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.
Keywords:critical careEchocardiographyGlobal longitudinal strainmortalitysepsisVentricular dysfunctionSee moreViews103Abstract
Original ArticleThe predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients
Critical Care Science. 2023;35(2):187-195
DOI 10.5935/2965-2774.20230378-en
- Timor Omar ,
- Kamil İnci ,
- Yusuf Oflu ,
- Mustafa Dilek ,
- Zeynep Binici Çelik ,
- Soner Kına ,
- Doğan İliş ,
- Halil Murat Bucak
Views103ABSTRACT
Objective:
Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients.
Methods:
This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission.
Results:
One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores.
Conclusion:
Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.
Keywords:critical careEchocardiographyGlobal longitudinal strainmortalitysepsisVentricular dysfunctionSee more
- Timor Omar
-
Special Article06-24-2022
Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti , [ ... ],
- Glenn Hernández
Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views181ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee moreViews181Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views181ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee more
- Eduardo Kattan
-
Original Article01-20-2019
Cardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure
- José Gorrasi ,
- Arturo Pazos,
- Lucia Florio,
- Carlos Américo,
- Natalia Lluberas, [ ... ],
- Ricardo Lluberas
Abstract
Original ArticleCardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure
Revista Brasileira de Terapia Intensiva. 2019;31(4):474-482
DOI 10.5935/0103-507X.20190073
- José Gorrasi ,
- Arturo Pazos,
- Lucia Florio,
- Carlos Américo,
- Natalia Lluberas,
- Gabriel Parma,
- Ricardo Lluberas
Views27ABSTRACT
Objective:
To compare cardiac output measurements by transthoracic echocardiography and a pulmonary artery catheter in mechanically ventilated patients with high positive end-expiratory pressure. To evaluate the effect of tricuspid regurgitation.
Methods:
Sixteen mechanically ventilated patients were studied. Cardiac output was measured by pulmonary artery catheterization and transthoracic echocardiography. Measurements were performed at different levels of positive end-expiratory pressure (10cmH2O, 15cmH2O, and 20cmH2O). The effect of tricuspid regurgitation on cardiac output measurement was evaluated. The intraclass correlation coefficient was studied; the mean error and limits of agreement were studied with the Bland-Altman plot. The error rate was calculated.
Results:
Forty-four pairs of cardiac output measurements were obtained. An intraclass correlation coefficient of 0.908 was found (p < 0.001). The mean error was 0.44L/min for cardiac output values between 5 and 13L/min. The limits of agreement were 3.25L/min and -2.37L/min. With tricuspid insufficiency, the intraclass correlation coefficient was 0.791, and without tricuspid insufficiency, 0.935. Tricuspid insufficiency increased the error rate from 32% to 52%.
Conclusions:
In patients with high positive end-expiratory pressure, cardiac output measurement by transthoracic echocardiography is comparable to that with a pulmonary artery catheter. Tricuspid regurgitation influences the intraclass correlation coefficient. In patients with high positive end-expiratory pressure, the use of transthoracic echocardiography to measure cardiac output is comparable to invasive measures.
Keywords:Cardiac OutputEchocardiographyHemodynamic MonitoringPositive end-expiratory pressurePulmonary Artery CatheterRespiration, artificialSee moreViews27Abstract
Original ArticleCardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure
Revista Brasileira de Terapia Intensiva. 2019;31(4):474-482
DOI 10.5935/0103-507X.20190073
- José Gorrasi ,
- Arturo Pazos,
- Lucia Florio,
- Carlos Américo,
- Natalia Lluberas,
- Gabriel Parma,
- Ricardo Lluberas
Views27ABSTRACT
Objective:
To compare cardiac output measurements by transthoracic echocardiography and a pulmonary artery catheter in mechanically ventilated patients with high positive end-expiratory pressure. To evaluate the effect of tricuspid regurgitation.
Methods:
Sixteen mechanically ventilated patients were studied. Cardiac output was measured by pulmonary artery catheterization and transthoracic echocardiography. Measurements were performed at different levels of positive end-expiratory pressure (10cmH2O, 15cmH2O, and 20cmH2O). The effect of tricuspid regurgitation on cardiac output measurement was evaluated. The intraclass correlation coefficient was studied; the mean error and limits of agreement were studied with the Bland-Altman plot. The error rate was calculated.
Results:
Forty-four pairs of cardiac output measurements were obtained. An intraclass correlation coefficient of 0.908 was found (p < 0.001). The mean error was 0.44L/min for cardiac output values between 5 and 13L/min. The limits of agreement were 3.25L/min and -2.37L/min. With tricuspid insufficiency, the intraclass correlation coefficient was 0.791, and without tricuspid insufficiency, 0.935. Tricuspid insufficiency increased the error rate from 32% to 52%.
Conclusions:
In patients with high positive end-expiratory pressure, cardiac output measurement by transthoracic echocardiography is comparable to that with a pulmonary artery catheter. Tricuspid regurgitation influences the intraclass correlation coefficient. In patients with high positive end-expiratory pressure, the use of transthoracic echocardiography to measure cardiac output is comparable to invasive measures.
Keywords:Cardiac OutputEchocardiographyHemodynamic MonitoringPositive end-expiratory pressurePulmonary Artery CatheterRespiration, artificialSee more
- José Gorrasi
-
Original Article10-14-2019
Respiratory distress syndrome: influence of management on the hemodynamic status of ≤ 32-week preterm infants in the first 24 hours of life
- Daniela Matos Fiorenzano ,
- Gabriela Nunes Leal,
- Karen Saori Shiraishi Sawamura,
- Alessandro Cavalcanti Lianza,
- Werther Brunow de Carvalho, [ ... ],
- Vera Lúcia Jornada Krebs
Abstract
Original ArticleRespiratory distress syndrome: influence of management on the hemodynamic status of ≤ 32-week preterm infants in the first 24 hours of life
Revista Brasileira de Terapia Intensiva. 2019;31(3):312-317
DOI 10.5935/0103-507X.20190056
- Daniela Matos Fiorenzano ,
- Gabriela Nunes Leal,
- Karen Saori Shiraishi Sawamura,
- Alessandro Cavalcanti Lianza,
- Werther Brunow de Carvalho,
- Vera Lúcia Jornada Krebs
Views81ABSTRACT
Objective:
To investigate the influence of respiratory distress syndrome management on clinical and echocardiographic parameters used for hemodynamic evaluation in ≤ 32- week newborns.
Methods:
Thirty-three ≤ 32-week newborns were prospectively evaluated and subjected to invasive mechanical ventilation. The need for exogenous surfactant and clinical and echocardiographic parameters in the first 24 hours of life was detailed in this group of patients.
Results:
The mean airway pressure was significantly higher in newborn infants who required inotropes [10.8 (8.8 - 23) cmH2O versus 9 (6.2 - 12) cmH2O; p = 0.04]. A negative correlation was found between the mean airway pressure and velocity-time integral of the pulmonary artery (r = -0.39; p = 0.026), right ventricular output (r = -0.43; p = 0.017) and measurements of the tricuspid annular plane excursion (r = -0.37; p = 0.036). A negative correlation was found between the number of doses of exogenous surfactant and the right ventricular output (r = -0.39; p = 0.028) and pulmonary artery velocity-time integral (r = -0.35; p = 0.043).
Conclusion:
In ≤ 32-week newborns under invasive mechanical ventilation, increases in the mean airway pressure and number of surfactant doses are correlated with the worsening of early cardiac function. Therefore, more aggressive management of respiratory distress syndrome may contribute to the hemodynamic instability of these patients.
Keywords:EchocardiographyHemodynamicsInfant, prematurePulmonary surfactantsRespiratory distress syndrome, newbornSee moreViews81Abstract
Original ArticleRespiratory distress syndrome: influence of management on the hemodynamic status of ≤ 32-week preterm infants in the first 24 hours of life
Revista Brasileira de Terapia Intensiva. 2019;31(3):312-317
DOI 10.5935/0103-507X.20190056
- Daniela Matos Fiorenzano ,
- Gabriela Nunes Leal,
- Karen Saori Shiraishi Sawamura,
- Alessandro Cavalcanti Lianza,
- Werther Brunow de Carvalho,
- Vera Lúcia Jornada Krebs
Views81ABSTRACT
Objective:
To investigate the influence of respiratory distress syndrome management on clinical and echocardiographic parameters used for hemodynamic evaluation in ≤ 32- week newborns.
Methods:
Thirty-three ≤ 32-week newborns were prospectively evaluated and subjected to invasive mechanical ventilation. The need for exogenous surfactant and clinical and echocardiographic parameters in the first 24 hours of life was detailed in this group of patients.
Results:
The mean airway pressure was significantly higher in newborn infants who required inotropes [10.8 (8.8 - 23) cmH2O versus 9 (6.2 - 12) cmH2O; p = 0.04]. A negative correlation was found between the mean airway pressure and velocity-time integral of the pulmonary artery (r = -0.39; p = 0.026), right ventricular output (r = -0.43; p = 0.017) and measurements of the tricuspid annular plane excursion (r = -0.37; p = 0.036). A negative correlation was found between the number of doses of exogenous surfactant and the right ventricular output (r = -0.39; p = 0.028) and pulmonary artery velocity-time integral (r = -0.35; p = 0.043).
Conclusion:
In ≤ 32-week newborns under invasive mechanical ventilation, increases in the mean airway pressure and number of surfactant doses are correlated with the worsening of early cardiac function. Therefore, more aggressive management of respiratory distress syndrome may contribute to the hemodynamic instability of these patients.
Keywords:EchocardiographyHemodynamicsInfant, prematurePulmonary surfactantsRespiratory distress syndrome, newbornSee more - Daniela Matos Fiorenzano
-
Review Article06-27-2019
Inferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications
Revista Brasileira de Terapia Intensiva. 2019;31(2):240-247
Abstract
Review ArticleInferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications
Revista Brasileira de Terapia Intensiva. 2019;31(2):240-247
DOI 10.5935/0103-507X.20190039
Views167See moreABSTRACT
The fluid resuscitation of patients with acute circulatory failure aims to increase systolic volume and consequently improve cardiac output for better tissue oxygenation. However, this effect does not always occur because approximately half of patients do not respond to fluids. The evaluation of fluid responsiveness before their administration may help to identify patients who would benefit from fluid resuscitation and avoid the risk of fluid overload in the others. The dynamic parameters of fluid responsiveness evaluation are promising predictive factors. Of these, the echocardiographic measurement of the respiratory variation in the inferior vena cava diameter is easy to apply and has been used in the hemodynamic evaluation of intensive care unit patients. However, the applicability of this technique has many limitations, and the present studies are heterogeneous and inconsistent across specific groups of patients. We review the use of the inferior vena cava diameter respiratory variation, measured via transthoracic echocardiography, to decide whether to administer fluids to patients with acute circulatory failure in the intensive care unit. We explore the benefits and limitations of this technique, its current use, and the existing evidence.
Views167Abstract
Review ArticleInferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications
Revista Brasileira de Terapia Intensiva. 2019;31(2):240-247
DOI 10.5935/0103-507X.20190039
Views167See moreABSTRACT
The fluid resuscitation of patients with acute circulatory failure aims to increase systolic volume and consequently improve cardiac output for better tissue oxygenation. However, this effect does not always occur because approximately half of patients do not respond to fluids. The evaluation of fluid responsiveness before their administration may help to identify patients who would benefit from fluid resuscitation and avoid the risk of fluid overload in the others. The dynamic parameters of fluid responsiveness evaluation are promising predictive factors. Of these, the echocardiographic measurement of the respiratory variation in the inferior vena cava diameter is easy to apply and has been used in the hemodynamic evaluation of intensive care unit patients. However, the applicability of this technique has many limitations, and the present studies are heterogeneous and inconsistent across specific groups of patients. We review the use of the inferior vena cava diameter respiratory variation, measured via transthoracic echocardiography, to decide whether to administer fluids to patients with acute circulatory failure in the intensive care unit. We explore the benefits and limitations of this technique, its current use, and the existing evidence.
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Case Report05-30-2019
Traumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture
Revista Brasileira de Terapia Intensiva. 2019;31(2):262-265
Abstract
Case ReportTraumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture
Revista Brasileira de Terapia Intensiva. 2019;31(2):262-265
DOI 10.5935/0103-507X.20190034
Views50See moreABSTRACT
Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
Views50Abstract
Case ReportTraumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture
Revista Brasileira de Terapia Intensiva. 2019;31(2):262-265
DOI 10.5935/0103-507X.20190034
Views50See moreABSTRACT
Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
Echocardiography Archives - Critical Care Science (CCS)
