Performance of a new pulse contour method for continuous cardiac output monitoring: validation in critically ill patients.

BACKGROUND: A new calibrated pulse wave analysis method (VolumeView™/EV1000™, Edwards Lifesciences, Irvine, CA, USA) has been developed to continuously monitor cardiac output (CO). The aim of this study was to compare the performance of the VolumeView method, and of the PiCCO2™ pulse contour method (Pulsion Medical Systems, Munich, Germany), with reference transpulmonary thermodilution (TPTD) CO measurements. METHODS: This was a prospective, multicentre observational study performed in the surgical and interdisciplinary intensive care units of four tertiary hospitals. Seventy-two critically ill patients were monitored with a central venous catheter, and a thermistor-tipped femoral arterial VolumeView™ catheter connected to the EV1000™ monitor. After initial calibration by TPTD CO was continuously assessed using the VolumeView-CCO software (CCO(VolumeView)) during a 72 h period. TPTD was performed in order to obtain reference CO values (COREF). TPTD and arterial wave signals were transmitted to a PiCCO2™ monitor in order to obtain CCO(PiCCO) values. CCO(VolumeView) and CCO(PiCCO) were recorded over a 5 min interval before assessment of CO(TPTD). Bland-Altman analysis, %(errors), and concordance (trend analysis) were calculated. RESULTS: A total of 338 matched sets of data were available for comparison. Bias for CCO(VolumeView)-CO(REF) was -0.07 litre min(-1) and for CCO(PiCCO)-CO(REF) +0.03 litre min(-1). Corresponding limits of agreement were 2.00 and 2.48 litre min(-1) (P<0.01), %(errors) 29 and 37%, respectively. Trending capabilities were comparable for both techniques. CONCLUSIONS: The performance of the new VolumeView™-CCO method is as reliable as the PiCCO2™-CCO pulse wave analysis in critically ill patients. However, an improved precision was observed with the VolumeView™ technique. CLINICALTRIALS.GOV IDENTIFIER: NCT01405040.

[Evaluation of skills required to practice advanced echocardiography in intensive care]. / Evaluation des compétences requises pour la pratique de l'échocardiographie à un niveau avancé aux soins intensifs.

In 2009, the Critical Care Network of the American College of Chest Physicians (ACCP) in partnership with La Sociéte de Reanimation de Langue Française selected a panel of experts to characterize competence in critical care ultrasonography. The task force developed a consensus and made recommendations concerning the qualifications in ultrasonography. Experts have identified specific skills that intensivit should acquire, by setting a minimum standard for the realisation and control of ultrasound. Last year, we published in the present journal the results of this consensus conference concerning the "basic echocardiography" for intensivit. This year, we summarize here the results of the consensus conference and its conclusions on the assessment of advanced level skills to practice echocardiography in intensive care.

[When the heart and/or the lung fails: the ECMO]. / Quand le coeur et/ou les poumons défaillent: oxygénation extracorporelle par "ECMO".

The Extra corporeal membrane oxygenation (ECMO) was initially proposed as a technique of respiratory support using an external membrane oxygenator. With time, it has also become a technique of cardiorespiratory support to ensure both gas exchange and organ perfusion until the restoration of organs function. This technical assistance can be central or peripheral and provides a partial or total circulatory support. The circuit includes a non occlusive centrifugal pump, an oxygenator for an enrichment of O2 and elimination of CO2 and cannulas for drainage and re-injection. Recently, the establishment of such assistance became possible percutaneously, allowing it to be initiated at the intensive care bedside or even before in-hospital admission.

[Physiopathologic aspects of microcirculation in intensive care]. / Aspects physiopathologiques de la microcirculation aux soins intensifs.

In critical care patients, microvascular alterations and perfusion heterogeneity play an important role in the persistence of cellular hypoxia despite a satisfactory functioning of the macrocirculation. Advance in the knowledge of microcirculatory pathophysiology, and its relation with the macrocirculation could be in the future a way to improve the outcome of critically ill patients. Moreover, the evolution of clinical practice towards microcirculation monitoring as a standard of care, with new therapeutic targets aimed to increase tissue perfusion, could be a revolution in critical care practice.

Unusual staphylococcal toxic shock syndrome presenting as a scarlet-like fever.

Diagnosis of nonmenstrual staphylococcal toxic shock syndrome (TSS) is often challenging. A female medical colleague had a rare entity, a staphylococcal pharyngitis complicated by TSS. The diagnosis was confirmed by isolation of tst-positive Staphylococcus aureus in throat culture and by identification of a specific Vß2 expansion pattern of her T lymphocytes. Recent improvements in microbiology can be of great help for the diagnosis of nonmenstrual TSS.

Evaluation of oxygen delivery in a patient with Berlin ExcorTM biventricular support.

After the implantation of a biventricular assist device hemodynamic evaluation is difficult. The device itself frequently does not report the real outflow as it does not take into account the native cardiac output. Other methods used for cardiac output measurements cannot be employed for technical reasons and/or because their measurements could be misleading. The consequences are twofold; firstly, cardiac output cannot be estimated with accuracy. Secondly, the adequacy of oxygen supply and demand cannot be assessed. In order to monitor the adequacy of cardiac output in patient with Berlin heart biventricular support, the authors propose an original non invasive method to measure mixed venous blood saturation.

[Microcirculatory alterations in critically ill patients: pathophysiology, monitoring and treatments]. / Altérations de la microcirculation dans les états de choc: physiopathologie, surveillance et traitement.

Microcirculation represents a complex system devoted to provide optimal tissue substrates and oxygen. Therefore, pathophysiological and technological knowledge developments tailored for capillary circulation analysis should generate major advances for critically ill patients' management. In the future, microcirculatory monitoring in several critical care situations will allow recognition of macro-microcirculatory decoupling, and, hopefully, it will promote the use of treatments aimed at preserving tissue oxygenation and substrate delivery.