Journal of critical care
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Journal of critical care · Dec 2013
Assessment of right ventricular functions in patients with sepsis, severe sepsis and septic shock and its prognostic importance: A tissue Doppler study.
This study aims to investigate the potential contributions of the right ventricle (RV) performance evaluated using tissue Doppler imaging (TDI) on the assessment of the severity and prognosis of sepsis. ⋯ Our study shows that the RV dysfunction evaluated using TDI, particularly the RV-Sm and MPI values, were related with the severity of sepsis and mortality.
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Journal of critical care · Dec 2013
Observational StudyEchocardiography to predict tolerance to negative fluid balance in acute respiratory distress syndrome/acute lung injury.
In acute respiratory distress syndrome (ARDS) and acute lung injury (ALI), a conservative fluid management strategy improves lung function but could jeopardize extrapulmonary organ perfusion. The objective was to evaluate the diagnostic accuracy of echocardiography to predict tolerance of negative fluid balance (NFB) in patients with ARDS/ALI. ⋯ The ratio of E/Ea accurately predicted tolerance of NFB in patients with ARDS/ALI.
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Journal of critical care · Dec 2013
Observational StudyNoninvasive assessment of hemodynamic response to a fluid challenge using femoral Doppler in critically ill ventilated patients.
The purpose of the study is to determine if femoral artery blood flow Doppler parameters can assess cardiac response to a fluid challenge (FC). ⋯ Variation of femoral Doppler parameters before and after FC mirrors cardiac response to fluid loading. This tool could be considered as an alternative to transthoracic echocardiography in case of poor thoracic insonation.
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Journal of critical care · Dec 2013
Bedside assessment of right atrial pressure in critically ill septic patients using tissue Doppler ultrasonography.
Right atrial pressure (RAP) is considered a surrogate for right ventricular filling pressure or cardiac preload. It is an important parameter for fluid management in patients with septic shock. It is commonly approximated by the central venous pressure (CVP) either invasively using a catheter placed in the superior vena cava or by bedside ultrasound, in which the size and respiratory variations of the inferior vena cava (IVC) are measured from the subcostal view. Doppler imaging of the tricuspid valve from the apical 4-chamber view has been proposed as an alternative approach for the estimation of RAP. The tricuspid E/Ea ratio is measured, where E is the peak velocity of the early diastolic tricuspid inflow and Ea is the peak velocity of the early diastolic relaxation of the lateral tricuspid annulus. We hypothesized that the tricuspid E/Ea ratio may represent an alternative to IVC metrics, using invasive CVP as the criterion standard, for the assessment of RAP in critically ill septic patients. ⋯ In this pilot study, Doppler imaging of the tricuspid valve provided a valuable alternative for noninvasive bedside estimation of RAP in septic patients.
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Journal of critical care · Dec 2013
Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock.
Central venous oxygen saturation (Scvo2) is a useful therapeutic target when treating septic shock. We hypothesized that combining Scvo2 and central venous-to-arterial partial pressure of carbon dioxide difference (△Pco2) may provide additional information about survival. ⋯ The combination of Scvo2 and △Pco2 appears to predict outcome in critically ill patients resuscitated from septic shock better than Scvo2 alone. Patients who meet both targets appear to clear lactate more efficiently.