المؤلفون: Hernandez Poblete, Glenn Wilson, Cavalcanti, Alexandre Biasi, Ospina-Tascón, Gustavo Adolfo, Zampieri, Fernando Godinho, Dubin, Arnaldo, Hurtado Bredda, Francisco Javier, Friedman, Gilberto, Castro Lopez, Ricardo Adolfo, Alegria Vargas, Leyla Morelia, Cecconi, Maurizio, Teboul, Jean-Louis, Bakker, Jan, The ANDROMEDA-SHOCK Study Investigators

مصطلحات موضوعية: Septic shock, Resuscitation, Peripheral perfusion, Lactate, Fluid responsiveness, Choque séptico, Ressuscitação, Reperfusão miocárdica, Deslocamentos de líquidos corporais, Ácido láctico

الوصف: Background: Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation. This article reports the rationale, study design and analysis plan of the ANDROMEDA-SHOCK Study. Methods: ANDROMEDA-SHOCK is a randomized controlled trial which aims to determine if a peripheral perfusiontargeted resuscitation is associated with lower 28-day mortality compared to a lactate-targeted resuscitation in patients with septic shock with less than 4 h of diagnosis. Both groups will be treated with the same sequential approach during the 8-hour study period pursuing normalization of capillary refill time versus normalization or a decrease of more than 20% of lactate every 2 h. The common protocol starts with fluid responsiveness assessment and fluid loading in responders, followed by a vasopressor and an inodilator test if necessary. The primary outcome is 28-day mortality, and the secondary outcomes are: free days of mechanical ventilation, renal replacement therapy and vasopressor support during the first 28 days after randomization; multiple organ dysfunction during the first 72 h after randomization; intensive care unit and hospital lengths of stay; and all-cause mortality at 90-day. A sample size of 422 patients was calculated to detect a 15% absolute reduction in mortality in the peripheral perfusion group with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Conclusions: If peripheral perfusion-targeted ...

وصف الملف: application/pdf

العلاقة: Annals of intensive care. Heidelberg : Springer-Verlag, 2011-. Vol. 8 (2018), 10 f.; http://hdl.handle.net/10183/180083Test; 001070298

الإتاحة: http://hdl.handle.net/10183/180083Test

المؤلفون: De Backer, Daniel, Bakker, Jan, Cecconi, Maurizio, Hajjar, Ludhmila, Liu, Da Wei, Lobo, Suzanna, Monnet, Xavier, Morelli, Andrea, Myatra, Sheila Neinan, Perel, Azriel, Pinsky, Michael R., Saugel, Bernd, Teboul, Jean-Louis, Vieillard-Baron, Antoine, Vincent, Jean-Louis

مصطلحات موضوعية: Critical care medicine, Hemodynamic monitoring, Cardiac output, Medical instruments and apparatus, Heart failure

الوصف: While the pulmonary artery catheter (PAC) is still interesting in specific situations, there are many alternatives. A group of experts from different backgrounds discusses their respective interests and limitations of the various techniques and related measured variables. The goal of this review is to highlight the conditions in which the alternative devices will suffice and when they will not or when these alternative techniques can provide information not available with PAC. The panel concluded that it is useful to combine different techniques instead of relying on a single one and to adapt the "package" of interventions to the condition of the patient. As a first step, the clinical and biologic signs should be used to identify patients with impaired tissue perfusion. Whenever available, echocardiography should be performed as it provides a rapid and comprehensive hemodynamic evaluation. If the patient responds rapidly to therapy, either no additional monitoring or pulse wave analysis (allowing continuous monitoring in case potential degradation is anticipated) can be applied. If the patient does not rapidly respond to therapy or complex hemodynamic alterations are observed, pulse wave analysis coupled with TPTD is suggested.

العلاقة: https://doi.org/10.7916/D8DJ6ZBMTest

الإتاحة: https://doi.org/10.7916/D8DJ6ZBMTest

المؤلفون: 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., Cardiovascular Dynamics Section of the ESICM

مصطلحات موضوعية: Intensive care units, Microcirculation, Septicemia, Hemodynamic monitoring, Critical care medicine

الوصف: Hand-held vital microscopes (HVMs) were introduced to observe sublingual microcirculatory alterations at the bedside in different shock states in critically ill patients. This consensus aims to provide clinicians with guidelines for practical use and interpretation of the sublingual microcirculation. Furthermore, it aims to promote the integration of routine application of HVM microcirculatory monitoring in conventional hemodynamic monitoring of systemic hemodynamic variables. METHODS: In accordance with the Delphi method we organized three international expert meetings to discuss the various aspects of the technology, physiology, measurements, and clinical utility of HVM sublingual microcirculatory monitoring to formulate this consensus document. A task force from the Cardiovascular Dynamics Section of the European Society of Intensive Care Medicine (with endorsement of its Executive Committee) created this consensus as an update of a previous consensus in 2007. We classified consensus statements as definitions, requirements, and/or recommendations, with a minimum requirement of 80% agreement of all participants. RESULTS: In this consensus the nature of microcirculatory alterations is described. The nature of variables, which can be extracted from analysis of microcirculatory images, is presented and the needed dataset of variables to identify microcirculatory alterations is defined. Practical aspects of sublingual HVM measurements and the nature of artifacts are described. Eleven statements were formulated that pertained to image acquisitions and quality statements. Fourteen statements addressed the analysis of the images, and 13 statements are related to future developments. CONCLUSION: This consensus describes 25 statements regarding the acquisition and interpretation of microcirculatory images needed to guide the assessment of the microcirculation in critically ill patients.

العلاقة: https://doi.org/10.7916/D89S37Q6Test

الإتاحة: https://doi.org/10.7916/D89S37Q6Test

المؤلفون: Hernandez, Glenn, Cavalcanti, Alexandre Biasi, Ospina‑Tascón, Gustavo, Zampieri, Fernando Godinho, Dubin, Arnaldo, Hurtado, F. Javier, Friedman, Gilberto, Castro, Ricardo, Alegría, Leyla, Cecconi, Maurizio, Teboul, Jean-Louis, Bakker, Jan, The ANDROMEDA-SHOCK Study Investigators

مصطلحات موضوعية: Critical care medicine, Resuscitation, Septic shock, Lactates

الوصف: Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate‐targeted resuscitation is the gold‐standard under current guidelines, although it has several pitfalls including that non‐hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion‐targeted resuscitation might provide a real‐time response to increases in ow that could lead to a more timely decision to stop resuscitation, thus avoiding uid overload and the risks of over‐resuscitation. This article reports the rationale, study design and analysis plan of the ANDROMEDA‐SHOCK Study. Methods: ANDROMEDA‐SHOCK is a randomized controlled trial which aims to determine if a peripheral perfusion‐ targeted resuscitation is associated with lower 28‐day mortality compared to a lactate‐targeted resuscitation in patients with septic shock with less than 4 h of diagnosis. Both groups will be treated with the same sequential approach during the 8‐hour study period pursuing normalization of capillary re ll time versus normalization or a decrease of more than 20% of lactate every 2 h. The common protocol starts with uid responsiveness assessment and uid loading in responders, followed by a vasopressor and an inodilator test if necessary. The primary outcome is 28‐day mortality, and the secondary outcomes are: free days of mechanical ventilation, renal replacement therapy and vasopressor support during the rst 28 days after randomization; multiple organ dysfunction during the rst 72 h after randomization; intensive care unit and hospital lengths of stay; and all‐cause mortality at 90‐day. A sample size of 422 patients was calculated to detect a 15% absolute reduction in mortality in the peripheral perfusion group with 90% power and two‐tailed type I error of 5%. All analysis will follow the intention‐to‐treat principle. Conclusions: If peripheral perfusion‐targeted resuscitation improves 28‐day ...

العلاقة: https://doi.org/10.7916/D82C0FPSTest

الإتاحة: https://doi.org/10.7916/D82C0FPSTest

المؤلفون: Geri, Guillaume, Stengel, Bénédicte, Jacquelinet, Christian, Aegerter, Philippe, Massy, Ziad A., Vieillard-Baron, Antoine, Legriel, Stéphane, Laurent, Virginie, Teboul, Jean-Louis, Tarazona, Anatole Virginie, Mekontso-Dessap, Armand, Mira, Jean-Paul, Diehl, Jean-Luc, Pirracchio, Romain, Bigé, Naike, Dupuis, Claire, Gaudry, Stéphane, Maizel, Julien, Souweine, Bertrand, Zafrani, Lara, Mégarbane, Bruno, Mebazaa, Alexandre, Durbach, Antoine, Audard, Vincent, Thervet, Eric, Boffa, Jean-Jacques, Hanouna, Guillaume, Titeca, Dimitri, Philiponnet, Carole, Glotz, Denis

المساهمون: Ministère des Affaires Sociales, de la Santé et des Droits des Femmes

المصدر: Annals of Intensive Care ; volume 8, issue 1 ; ISSN 2110-5820

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الوصف: Background Acute kidney injury (AKI) is frequent and associated with poor outcome in intensive care unit (ICU) patients. Besides the association with short- and long-term mortality, the increased risk of chronic kidney disease (CKD) has been recently highlighted in non-ICU patients. This study aims to describe the incidence and determinants of CKD after AKI and to develop a prediction score for CKD in ICU patients. Methods Prospective multicenter ( n = 17) observational study included 1200 ICU patients who suffered from AKI (defined by an AKIN stage ≥ 1) during their ICU stay and were discharged alive from ICU. Preexisting end-stage renal disease (ESRD) and immunosuppressant treatments are the main exclusion criteria. Patients will be monitored by a nephrologist at day 90 and every year for 3 years. The main outcome is the occurrence of CKD defined by a creatinine-based estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m 2 or renal replacement therapy for ESRD in patients whose eGFR will be normalized (≥ 60 mL/min/1.73 m 2 ) at day 90. Secondary outcomes include albuminuria changes, eGFR decline slope and ESRD risk in patients with preexisting CKD, cardiovascular and thromboembolic events and health-related quality of life. Discussion This is the first study prospectively investigating kidney function evolution in ICU patients who suffered from AKI. Albuminuria and eGFR monitoring will allow to identify ICU patients at risk of CKD who may benefit from close surveillance after recovering from AKI. Major patient and AKI-related determinants will be tested to develop a prediction score for CKD in this population. Trial registration ClinicalTrials.gov, NCT03282409. Registered on September 14, 2017

الإتاحة: https://doi.org/10.1186/s13613-018-0421-7Test

المؤلفون: Cecconi, Maurizio, Hernandez, Glenn, Dunser, Martin, Antonelli, Massimo, Baker, Tim, Bakker, Jan, Duranteau, Jacques, Einav, Sharon, Groeneveld, A. B. Johan, Harris, Tim, Jog, Sameer, Machado, Flavia R., Mer, Mervyn, Monge García, M. Ignacio, Myatra, Sheila Nainan, Perner, Anders, Teboul, Jean-Louis, Vincent, Jean-Louis, De Backer, Daniel

المصدر: Intensive Care Medicine ; volume 45, issue 1, page 136-136 ; ISSN 0342-4642 1432-1238

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الإتاحة: https://doi.org/10.1007/s00134-018-5485-1Test

المؤلفون: Girotto, Valentina, Teboul, Jean-Louis, Beurton, Alexandra, Galarza, Laura, Guedj, Thierry, Richard, Christian, Monnet, Xavier

المصدر: Annals of Intensive Care ; volume 8, issue 1 ; ISSN 2110-5820

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الإتاحة: https://doi.org/10.1186/s13613-018-0413-7Test

المؤلفون: Malbrain, Manu L. N. G., Van Regenmortel, Niels, Saugel, Bernd, De Tavernier, Brecht, Van Gaal, Pieter-Jan, Joannes-Boyau, Olivier, Teboul, Jean-Louis, Rice, Todd W., Mythen, Monty, Monnet, Xavier

المصدر: Annals of Intensive Care ; volume 8, issue 1 ; ISSN 2110-5820

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الإتاحة: https://doi.org/10.1186/s13613-018-0402-xTest

المؤلفون: Monnet, Xavier, Teboul, Jean-Louis

المصدر: Annals of Intensive Care ; volume 8, issue 1 ; ISSN 2110-5820

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الإتاحة: https://doi.org/10.1186/s13613-018-0400-zTest

المؤلفون: Monnet, Xavier, Teboul, Jean-Louis

المصدر: Critical Care ; volume 22, issue 1 ; ISSN 1364-8535

مصطلحات موضوعية: Critical Care and Intensive Care Medicine

الإتاحة: https://doi.org/10.1186/s13054-018-1957-5Test