medigraphic.com
ISSN 1810-2352 (Print)

2020, Number 2

<< Back Next >>

Rev Cub Med Int Emerg 2020; 19 (2)

Advanced hemodynamic monitoring associated with simultaneous ultrasound to hemogasometric variables in critically patient

Castellanos GA, Abdo CA, Quevedo BY, Leal AG, Castellanos GR, Gómez PF, Pérez AG, Gutiérrez MJA, Espinosa NN, López GJC, Díaz PG, Cordero VY, Quiles GLM, Hernández FE

Language: Spanish
References: 22
Page: 1-7
PDF size: 442.29 Kb.


ABSTRACT

Introduction: Monitoring cardiac output by pulse wave contour analysis is one of the advanced methods of the hemodynamic study, with limited availability, though. Alterations in oxygenation, carbon dioxide metabolism and ultrasound, which are simultaneously determined, could estimate hemodynamic changes similar to those of the pulse wave contour.
Objective: To identify the correlation between variables obtained through the pulse wave contour method and variables obtained by ultrasound, tissue oxygenation and carbon dioxide.
Methods: An observational, analytical, cross-sectional study was conducted in the Intensive Care Unit at the Medical-Surgical Research Center, from March 2016 to January 2017. Ten critically ill patients with various diagnostic diseases were studied. Twenty-one hemodynamic estimates were made at different times. Previously, the ultrasound protocol was applied to these patients, and variables of systemic oxygenation and venous-to-arterial carbon dioxide tension difference were determined.
Results: Correlation was observed between cardiac index and DvaCO2 (ρ = -0.498 p = 0.022), decreased contractility, and absence of inspiratory collapse of the inferior vena cava (X2 = 11.422 p = 0.001; X2 = 6.43 p = 0.011; respectively). A correlation was detected between the extravascular lung water index (ELWI and the number of B lines, PO2 / FiO2 ratio (ρ = 0.491 p = 0.024; ρ = 0.811 p = 0.000; ρ = -0.554 p = 0.009; respectively) and the presence of A lines (X2 = 4, 42 p = 0.035).
Conclusions: A significant association between oxygenation variables, carbon dioxide, and ultrasound was observed, with the cardiac index and the extravascular pulmonary water.


REFERENCES

  1. Huygh J, Peeters Y, Bernards J, Malbrain M. Hemodynamic monitoring in the critically ill: an overview of current cardiac output monitoring methods. F1000Research. 2016;5: F1000 Faculty Rev-2855. Doi: 10.12688/f1000research.8991.1

  2. Paul L. Marino. Chapter 8 The Pulmonary Artery Catheter. En: Brown B, Dernoski N, editores. Marino’s The ICU Book. 4 ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p 125-40.

  3. Danin P, Siegenthaler N, Levraut J, Bernardin G, Dellamonica J, Bendjelid K. Monitoring CO2 in shock states. J Clin Monit Comput. 2015;29:591-600.

  4. Mahajan R, Peter J, John G, Graham P, Rao S, Pinsky M. Patterns of central venous oxygen saturation, lactate and veno-arterial CO difference in patients with septic shock. Indian J Crit Care Med. 2015;19(10):580-6.

  5. Paul L Marino. Chapter 10 Systemic Oxygenation. En: Brown B, Dernoski N, editores. Marino’s The ICU Book. 4 ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p 157-79.

  6. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically Ill. Emerg Med Clin N Am. 2010;28:29-56.

  7. Reza M, Hadi M, Ebrahimi M, Samimi K, Rezaee M, Rasouli HR, et al. Accuracy of Rapid Ultrasound in Shock (RUSH) Exam for Diagnosis of Shock in Critically Ill Patients. Trauma Mon. 2015;20(1):5.

  8. Bagheri-Hariri S, Yekesadat M, Farahmand S, Arbab M, Sedaghat M, Shahlafar N, et al. The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department. Emerg Radiol. 2015;22:517-20.

  9. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369(18):1726-34. Doi: 10.1056/NEJMra1208943

  10. McLean AS. Echocardiography in shock management. Critical Care. 2016;20(275):1-10.

  11. Dres M, Monnet X, Teboul J. Hemodynamic management of cardiovascular failure by using PCO2 venous-arterial difference. J Clin Monit Comput. 2012;26:367-74.

  12. Naumann D, Midwinter M, Hutchings S. Venous-to-arterial CO2 differences and the quest for bedside point-of-care monitoring to assess the microcirculation during shock. Ann Transl Med. 2016;4(2):37.

  13. Mallat J, Lemyze M, Tronchon L, Vallet B, Thevenin D. Use of venous-to-arterial carbon dioxide tension difference to guide resuscitation therapy in septic shock. World J Crit Care Med. 2016;5(1):47-56.

  14. Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulmonary Medicine. 2015;15:98.

  15. Ha Y, Toh H. Clinically integrated multi-organ point-ofcare ultrasound for undifferentiated respiratory difficulty, chest pain, or shock: a critical analytic review. Journal of Intensive Care. 2016;4:54.

  16. Picano E, Pellikka P. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. European Heart Journal. 2016;37:2097-104.

  17. Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jörres A, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Critical Care. 2015;19:36.

  18. Bataille B, Rao G, Cocquet P, Mora M, Masson B, Ginot J, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. J Clin Monit Comput. 2015;29:169-76.

  19. Cueto A, Quevedo Y, Abdo A, Alonso P, Martínez R, Leal G. Ultrasonografía torácica en la valoración hemodinámica del paciente crítico en comparación con parámetros de termodilución transpulmonar. Invest Medicoquir. 2017;9(1):26-38.

  20. Elbaih A, Housseini A, Khalifa EM. Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients. Chinese Journal of Traumatology. 2018;21:156-62.

  21. Gui J, Yang Z, Ou B, Xu A, Yang F, Chen Q, et al. Is the Collapsibility Index of the Inferior Vena Cava an Accurate Predictor for the Early Detection of Intravascular Volume Change? Shock. 2018;49(1):29-32.

  22. Millington SJ. Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful. Can J Anaesth. 2019;66(6):633-8. Doi: 10.1007/s12630-019-01357-0




2020     |     www.medigraphic.com