Guidelines for inhaled sedation in the ICU.

INTRODUCTION AND OBJECTIVES: Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY: Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS: The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION: The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.

Correction to: The oxygen reserve index (ORI): a new tool to monitor oxygen therapy.

In the original publication of the article, the authors have realized an error in Fig. 1. The corrected version of Fig. 1 is given below.

Individualized lung recruitment maneuver guided by pulse-oximetry in anesthetized patients undergoing laparoscopy: a feasibility study.

BACKGROUND: We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2 ) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2  ≥ 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2 ≥ 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2  < 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure. RESULTS: When breathing air, in 24 of 30 patients SpO2 was < 97%, PaO2 /FIO2  Ë‚ 53.3 kPa and negative end-expiratory transpulmonary pressure (PTP-EE ). The mean (SD) opening pressures were found at 40 (5) and 33 (4) cmH2 O during the first and second RM, respectively (P < 0.001; 95% CI: 3.2-7.7). The closing pressure was found at 11 (5) cmH2 O. This SpO2 -guided approach increased PTP-EE (from -6.4 to 1.2 cmH2 O, P < 0.001) and PaO2 /FIO2 (from 30.3 to 58.1 kPa, P < 0.001) while decreased driving pressure (from 18 to 10 cmH2 O, P < 0.001). SpO2 discriminated the lung's opening and closing pressures with accuracy taking the reference parameter PTP-EE (area under the receiver-operating-curve of 0.89, 95% CI: 0.80-0.99). CONCLUSION: The non-invasive SpO2 monitoring can help to individualize an open-lung approach, including all involved steps, from the identification of those patients who can benefit from recruitment, the identification of opening and closing pressures to the subsequent monitoring of an open-lung condition.

The oxygen reserve index (ORI): a new tool to monitor oxygen therapy.

Supplemental oxygen is administered in the vast majority of patients in the perioperative setting and in the intensive care unit to prevent the potentially deleterious effects of hypoxia. On the other hand, the administration of high concentrations of oxygen may induce hyperoxia that may also be associated with significant complications. Oxygen therapy should therefore be precisely titrated and accurately monitored. Although pulse oximetry has become an indispensable monitoring technology to detect hypoxemia, its value in assessing the oxygenation status beyond the range of maximal arterial oxygen saturation (SpO2 ≥97%) is very limited. In this hyperoxic range, we need to rely on blood gas analysis, which is intermittent, invasive and sometimes delayed. The oxygen reserve index (ORI) is a new continuous non-invasive variable that is provided by the new generation of pulse oximeters that use multi-wavelength pulse co-oximetry. The ORI is a dimensionless index that reflects oxygenation in the moderate hyperoxic range (PaO2 100-200 mmHg). The ORI may provide an early alarm when oxygenation deteriorates well before any changes in SpO2 occur, may reflect the response to oxygen administration (e.g., pre-oxygenation), and may facilitate oxygen titration and prevent unintended hyperoxia. In this review we describe this new variable, summarize available data and preliminary experience, and discuss its potential clinical utilities in the perioperative and intensive care settings.

[Non-invasive mechanical ventilation in postoperative patients. A clinical review]. / Ventilación mecánica no invasiva en el postoperatorio. Revisión clínica.

Non-invasive ventilation (NIV) is a method of ventilatory support that is increasing in importance day by day in the management of postoperative respiratory failure. Its role in the prevention and treatment of atelectasis is particularly important in the in the period after thoracic and abdominal surgeries. Similarly, in the transplanted patient, NIV can shorten the time of invasive mechanical ventilation, reducing the risk of infectious complications in these high-risk patients. It has been performed A systematic review of the literature has been performed, including examining the technical, clinical experiences and recommendations concerning the application of NIV in the postoperative period.

[Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway]. / Ventilación mecánica no invasiva en pre eintraoperatorio y vía aérea difícil.

Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients.

Renal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: a comparison with intravenous propofol sedation in an animal model.

INTRODUCTION: Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72h) of sevoflurane. METHODS: For this experimental, prospective, randomized, controlled trial, 22 Landrace x Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhaled sevoflurane via the AnaConDa™ device (S, end-tidal 2.5 vol%). The P group remained sedated for 108h with propofol. In the S group, sevoflurane was administered for 72h and then changed to propofol for the remaining 36h in order to observe the kinetics of fluoride after discontinuation of sevoflurane. Serum creatinine was the primary outcome variable, but inorganic fluoride concentrations and other renal, hepatic, and cardiorespiratory variables were also measured. RESULTS: Both groups of animals were comparable at baseline. No differences were found between the two groups for plasma creatinine and urea or creatinine clearance throughout the study. Fluoride levels were significantly higher in the sevoflurane group. No correlation was found between inorganic fluoride and serum creatinine values. No significant differences were observed for hepatic function. Hemodynamic, respiratory, and blood gas variables were comparable between the groups. CONCLUSIONS: Long-term sedation with sevoflurane using AnaConDa™ or propofol does not negatively affect renal or hepatic function.

Hipertensión endocraneal asociada a la sedación con sevoflurano mediante el dispositivo AnaConDa ®en un paciente con traumatismo craneoencefálico severo / Intracranial hypertension related to sedation with sevoflurane using the AnaConDa ® device in a patient with severe traumatic brain injury

La sedación en los pacientes neurocríticos es difícil, debido a que ningún fármaco cumple todos los requisitos. Desde la aparición del dispositivo AnaConDa® y según las últimas recomendaciones, el sevoflurano se ha convertido en una alternativa para el paciente neurocrítico. Una de las consecuencias de la utilización del dispositivo es el aumento del espacio muerto anatómico instrumental que produce una disminución de la ventilación alveolar. Si la disminución de la ventilación alveolar no se compensa con un aumento del volumen minuto se producirá un aumento de la PaCO2. Presentamos el caso de un paciente con traumatismo craneoencefálico severo en el que se produjo un aumento de la presión endocraneal como consecuencia del aumento de la PaCO2 tras colocar el dispositivo AnaConDa® para sedación (AU)

[Intracranial hypertension related to sedation with sevoflurane using the AnaConDa(®) device in a patient with severe traumatic brain injury]. / Hipertensión endocraneal asociada a la sedación con sevoflurano mediante el dispositivo AnaConDa(®)en un paciente con traumatismo craneoencefálico severo.

Sedation in neurocritical patients remains a challenge as there is no drug that meets all the requirements. Since the appearance of the AnaConDa(®) device, and according to the latest recommendations, sevoflurane has become an alternative for patients with brain injury. The use of AnaConDa(®) produces an increase in the anatomical dead space that leads to a decrease in alveolar ventilation. If the decrease in the alveolar ventilation is not offset by an increase in minute volume, there will be an increase in PaCO2. We report the case of a patient with severe traumatic brain injury who suffered an increase in intracranial pressure as a result of increased PaCO2 after starting sedation with the AnaConDa(®) device.

Airway pressure curve: a good tool to measure neural inspiratory time?

BACKGROUND: Considerable asynchrony during pressure-support ventilation has been reported. While the beginning of active inspiration is usually identifiable in the airway pressure (Paw) curve (the inspiratory trigger), there is still a need for accurate, non-invasive methods to identify the end of inspiration. To test the hypothesis that inspiration, particularly the end of inspiration, can be estimated from the Paw curve, we compared indirect measurements based on Paw with simultaneous direct electromyography of the diaphragm (EMGdi). METHODS: We prospectively studied 10 patients during the weaning period after cardiac surgery. Inspiratory pressure support was set at 20, 15, 10, and 5 cm H(2)O; 25 respiratory cycles were analyzed at each pressure level. Recording of the electromyogram was obtained with electrodes inserted into the diaphragm during surgery. RESULTS: The start and end of inspiration were identified in the Paw curve in 99% and 98% of the 1000 cycles analyzed, respectively, and were coincident with the electromyogram in 62% and 53% of the cycles, respectively. The inspiratory time estimated from the Paw curve was well correlated (r=0.94, P<0.0001) with the electromyogram. CONCLUSION: The end of neural inspiration (EMGdi) can be easily and with little error recognized from the Paw curve alone in patients with normal ventilatory mechanics who receive pressure-support ventilation.

Complications related to less-invasive haemodynamic monitoring.

BACKGROUND: The aim of this study was to evaluate the type and incidence of complications during insertion, maintenance, and withdrawal of central arterial catheters used for transpulmonary thermodilution haemodynamic monitoring (PiCCO™). METHODS: We conducted a prospective, observational, multicentre study in 14 European intensive care units (six countries). A total of 514 consecutive patients in whom haemodynamic monitoring by PiCCO™ was indicated were studied. RESULTS: Five hundred and fourteen PiCCO catheters (475 in femoral, 26 in radial, nine in axillary, and four in brachial arteries) were inserted. Arterial access was obtained on the first attempt in 86.4% of the patients. Minor problems such as oozing after insertion (3.3%) or removal of the catheter (3.5%) were observed, but no episodes of serious bleeding (more than 50 ml) were recorded. Small local haematomas were observed after insertion (4.5%) and after removal (1.2%) of the catheter. These complications were not more frequent in patients with coagulation abnormalities. The incidence of site inflammation and catheter-related infection was 2% and 0.78%, respectively. Other complications such as ischaemia (0.4%), pulse loss (0.4%), or femoral artery thrombosis (0.2%) were rare, transient, and all resolved with catheter removal or embolectomy, respectively. CONCLUSIONS: In this series of patients, central arterial catheters used for PiCCO™ monitoring were demonstrated to be a safe alternative for advanced haemodynamic monitoring.

[Clinical validation of minimally invasive evaluation of systolic function]. / Validación clínica de la valoración mínimamente invasiva de la función sistólica.

BACKGROUND AND OBJECTIVE: Pulse contour continuous cardiac output (PiCCO) monitoring by means of transpulmonary thermodilution provides 2 indices of systolic function: the cardiac function index and the global ejection fraction. Our aim was to compare these 2 PiCCO indices to the left-ventricular ejection fraction obtained by transthoracic echocardiography. MATERIAL AND METHODS: This was a prospective clinical study of 35 adult patients in the critical care unit of a university hospital. Each patient provided his or her own control data. Patients with marked changes in regional segment contractility or nonsinus rhythm were excluded. We collected patient variables, reason for admission to the critical care unit, the Acute Physiology and Chronic Health Evaluation II score, the reason for hemodynamic monitoring, and the infusion of vasoactive drugs at the time of the procedure. RESULTS: Statistically significant correlations were found between the left-ventricular ejection fraction and the global ejection fraction (r=0.79, P<.001) and the cardiac function index (r=0.66, P<.001). The mean (SD) difference between the left-ventricular ejection fraction and the global ejection fraction and the cardiac function index were 1.05% (10.2%) (range, 19.0% to 29.1%) and 0.001% (12.4%) (range, -24.3% to 24.3%), respectively. For predicting a left-ventricular ejection fraction of less than 40%, the area under the curve was 0.879 for the global ejection fraction and 0.805 for the cardiac function index of A global ejection fraction less than 13.5% and a cardiac function index less than 3.15 min(-1) predicted a left-ventricular ejection fraction less than 40% with sensitivities of 97% and 96% and specificities of 85% and 77%, respectively. CONCLUSIONS: In patients without marked changes in regional segment contractility, the global ejection fraction and the cardiac function index calculated by the PiCCO monitor offer a reliable and simple way to assess left-ventricular systolic function. Low values for these indicators suggest the need for echocardiographic assessment of left- and right-ventricular function.

Validación clínica de la valoración mínimamente invasiva de la función sistólica / Clinical validation of minimally invasive evaluation of systolic function

OBJETIVO: El monitor PiCCO®, mediante la técnica de termodilución transpulmonar (TDTP), ofrece dos índices de valoración de la función sistólica: el índice de función cardiaca (IFC) y la fracción de eyección global (FEG). En este estudio comparamos estos índices con la fracción de eyección del ventrículo izquierdo medida por ecocardiografía transtorácica. MATERIAL Y MÉTODO: Estudio clínico prospectivo de 35 pacientes adultos ingresados en una unidad de críticos de un hospital universitario. Cada paciente fue su propio control. Se excluyeron enfermos con alteraciones graves de la contractilidad segmentaria, así como los que tenían un ritmo cardiaco no sinusal. Se recogieron los datos demográficos, el motivo de ingreso en la unidad de cuidados críticos, el valor del APACHE II (Acute Physiology And Chronic Health Evaluation), el motivo de la monitorización hemodinámica y la infusión de fármacos vasoactivos en el momento de la exploración. Mediante el monitor PiCCO® se obtuvo el valor de la fracción de eyección global y el índice de función cardiaca. A su vez, se midió la fracción de eyección del ventrículo izquierdo mediante ecocardiografía transtorácica. RESULTADOS: Se encontraron correlaciones estadísticamente significativas de la fracción de eyección del ventrículo izquierdo con la FEG y el IFC (r=0,79; p<0,001 y r=0,66; p<0,001, respectivamente). La diferencia media entre los valores de la fracción de eyección del ventrículo izquierdo medidos y estimados por FEG e IFC fue de 1,05 ± 10,2% (rango -19,0 a 29,1) y 0,001 ± 12,4% (rango -24,3 a 24,3) respectivamente. El área bajo la curva para estimar una fracción de eyección del ventrículo izquierdo inferior a 40% fue 0,879 y 0,805 para la FEG e IFC respectivamente. La FEG inferior a 13,5% y el IFC inferior a 3,15 min-1 detectan una fracción de eyección del ventrículo izquierdo inferior a 40% con una sensibilidad del 97% y 96% y una especificidad del 85% y 77%, respectivamente. CONCLUSIONES: En pacientes sin alteraciones severas de la contractilidad segmentaria, los índices de contractilidad FEG e IFC obtenidos con el monitor PiCCO® constituyen una herramienta fiable y sencilla para la valoración de la función sistólica del ventrículo izquierdo. Valores bajos de estos índices nos deben incitar a realizar un estudio ecocardiográfico para valorar la función ventricular derecha e izquierda(AU)

BACKGROUND AND OBJECTIVE: Pulse contour continuous cardiac output (PiCCO) monitoring by means of transpulmonary thermodilution provides 2 indices of systolic function: the cardiac function index and the global ejection fraction. Our aim was to compare these 2 PiCCO indices to the left-ventricular ejection fraction obtained by transthoracic echocardiography. MATERIAL AND METHODS: This was a prospective clinical study of 35 adult patients in the critical care unit of a university hospital. Each patient provided his or her own control data. Patients with marked changes in regional segment contractility or nonsinus rhythm were excluded. We collected patient variables, reason for admission to the critical care unit, the Acute Physiology and Chronic Health Evaluation II score, the reason for hemodynamic monitoring, and the infusion of vasoactive drugs at the time of the procedure. RESULTS: Statistically significant correlations were found between the left-ventricular ejection fraction and the global ejection fraction (r=0.79, P<.001) and the cardiac function index (r=0.66, P<.001). The mean (SD) difference between the left-ventricular ejection fraction and the global ejection fraction and the cardiac function index were 1.05% (10.2%) (range, 19.0% to 29.1%) and 0.001% (12.4%) (range, –24.3% to 24.3%), respectively. For predicting a left-ventricular ejection fraction of less than 40%, the area under the curve was 0.879 for the global ejection fraction and 0.805 for the cardiac function index of A global ejection fraction less than 13.5% and a cardiac function index less than 3.15 min-1 predicted a left-ventricular ejection fraction less than 40% with sensitivities of 97% and 96% and specificities of 85% and 77%, respectively. CONCLUSIONS: In patients without marked changes in regional segment contractility, the global ejection fraction and the cardiac function index calculated by the PiCCO monitor offer a reliable and simple way to assess left-ventricular systolic function. Low values for these indicators suggest the need for echocardiographic assessment of left- and right-ventricular function(AU)

Validación clínica de la valoración mínimamente invasiva de la función sistólica / Clinical validation of minimally invasive evaluation of systolic function

OBJETIVO: El monitor PiCCO(R), mediante la técnica de termodilución transpulmonar (TDTP), ofrece dos índices de valoración de la función sistólica: el índice de función cardiaca (IFC) y la fracción de eyección global (FEG). En este estudio comparamos estos índices con la fracción de eyección del ventrículo izquierdo medida por ecocardiografía transtorácica. MATERIAL Y MÉTODO: Estudio clínico prospectivo de 35 pacientes adultos ingresados en una unidad de críticos de un hospital universitario. Cada paciente fue su propio control. Se excluyeron enfermos con alteraciones graves de la contractilidad segmentaria, así como los que tenían un ritmo cardiaco no sinusal. Se recogieron los datos demográficos, el motivo de ingreso en la unidad de cuidados críticos, el valor del APACHE II (Acute Physiology And Chronic Health Evaluation), el motivo de la monitorización hemodinámica y la infusión de fármacos vasoactivos en el momento de la exploración. Mediante el monitor PiCCO® se obtuvo el valor de la fracción de eyección global y el índice de función cardiaca. A su vez, se midió la fracción de eyección del ventrículo izquierdo mediante ecocardiografía transtorácica. RESULTADOS: Se encontraron correlaciones estadísticamente significativas de la fracción de eyección del ventrículo izquierdo con la FEG y el IFC (r=0,79; p<0,001 y r=0,66; p<0,001, respectivamente). La diferencia media entre los valores de la fracción de eyección del ventrículo izquierdo medidos y estimados por FEG e IFC fue de 1,05 ± 10,2% (rango -19,0 a 29,1) y 0,001 ± 12,4% (rango -24,3 a 24,3) respectivamente. El área bajo la curva para estimar una fracción de eyección del ventrículo izquierdo inferior a 40% fue 0,879 y 0,805 para la FEG e IFC respectivamente. La FEG inferior a 13,5% y el IFC inferior a 3,15 min-1 detectan una fracción de eyección del ventrículo izquierdo inferior a 40% con una sensibilidad del 97% y 96% y una especificidad del 85% y 77%, respectivamente. CONCLUSIONES: En pacientes sin alteraciones severas de la contractilidad segmentaria, los índices de contractilidad FEG e IFC obtenidos con el monitor PiCCO® constituyen una herramienta fiable y sencilla para la valoración de la función sistólica del ventrículo izquierdo. Valores bajos de estos índices nos deben incitar a realizar un estudio ecocardiográfico para valorar la función ventricular derecha e izquierda(AU)

BACKGROUND AND OBJECTIVE: Pulse contour continuous cardiac output (PiCCO) monitoring by means of transpulmonary thermodilution provides 2 indices of systolic function: the cardiac function index and the global ejection fraction. Our aim was to compare these 2 PiCCO indices to the left-ventricular ejection fraction obtained by transthoracic echocardiography. MATERIAL AND METHODS: This was a prospective clinical study of 35 adult patients in the critical care unit of a university hospital. Each patient provided his or her own control data. Patients with marked changes in regional segment contractility or nonsinus rhythm were excluded. We collected patient variables, reason for admission to the critical care unit, the Acute Physiology and Chronic Health Evaluation II score, the reason for hemodynamic monitoring, and the infusion of vasoactive drugs at the time of the procedure. RESULTS: Statistically significant correlations were found between the left-ventricular ejection fraction and the global ejection fraction (r=0.79, P<.001) and the cardiac function index (r=0.66, P<.001). The mean (SD) difference between the left-ventricular ejection fraction and the global ejection fraction and the cardiac function index were 1.05% (10.2%) (range, 19.0% to 29.1%) and 0.001% (12.4%) (range, –24.3% to 24.3%), respectively. For predicting a left-ventricular ejection fraction of less than 40%, the area under the curve was 0.879 for the global ejection fraction and 0.805 for the cardiac function index of A global ejection fraction less than 13.5% and a cardiac function index less than 3.15 min-1 predicted a left-ventricular ejection fraction less than 40% with sensitivities of 97% and 96% and specificities of 85% and 77%, respectively. CONCLUSIONS: In patients without marked changes in regional segment contractility, the global ejection fraction and the cardiac function index calculated by the PiCCO monitor offer a reliable and simple way to assess left-ventricular systolic function. Low values for these indicators suggest the need for echocardiographic assessment of left- and right-ventricular function(AU)

Elimination capacity of a TSE-model agent in the manufacturing process of Alphanate/Fanhdi, a human factor VIII/VWF complex concentrate.

The variant Creutzfeldt-Jakob disease (vCJD) is a transmissible spongiform encephalopathy (TSE), mainly present in the UK and is associated with the ingestion of bovine products affected with bovine spongiform encephalopathy. Manufacturers of biological products must investigate the ability of their production processes to remove TSE agents. We studied the purification steps in the manufacturing process of two FVIII/VWF concentrates (Alphanate) and Fanhdi in their ability to eliminate an experimental TSE-model agent. Hamster scrapie strain 263K brain-derived materials were spiked into samples of the solutions taken before various stages during its production: 3.5% polyethylene glycol (PEG) precipitation, heparin affinity chromatography and saline precipitation/final filtrations. PEG precipitation and affinity chromatography were studied both as isolated and combined steps. TSE agent removal was determined using a laboratory scale model representative of the industrial manufacturing process. The prion protein (PrP(Sc)) was measured with Western blot and TSE infectivity was measured with bioassay. Western blot results were in agreement with those obtained by bioassay, showing a significant removal capacity in the production process: 3.21-3.43 log(10) for the PEG precipitation; about 3.45 log(10) for the affinity chromatography; and around 2.0 log(10) for the saline precipitation plus final filtrations. PEG precipitation and heparin affinity chromatography were demonstrated to be two complementary TSE-model agent removal mechanisms with total removal being the sum of the two. An overall reduction factor of around 8 log(10) can be deduced. The tests from the production process of FVIII/VWF complex concentrates have demonstrated their potential for eliminating TSE agents.

[Minimally invasive cardiopulmonary monitoring with the PiCCO Plus system]. / PiCCO plus: monitorización cardiopulmonar mínimamente invasiva.

Insertion of a central venous catheter and an arterial catheter would be indicated in hemodynamically unstable or severely hypoxic patients in critical care units. In this setting, cardiorespiratory monitoring by transpulmonary thermodilution (TPTD) can be considered minimally invasive given that only a single arterial thermodilution catheter and a single central venous catheter are required to be connected to a specific monitor (the PiCCO Plus, Pulsion Medical Systems, Munich, Germany). TDTP simultaneously measures cardiac output, preloading, and cardiac function in hemodynamically unstable patients and predicts the response to volume. The technique can be managed by any health care professional. In hypoxic patients, TDTP identifies cases of pulmonary edema that might benefit from a negative fluid balance, evaluates pulmonary vascular permeability, facilitates our understanding of pathophysiologic mechanisms of hypoxemia, and predicts the likelihood of deleterious hemodynamic effects of positive end-expiratory pressures.

PiCCO plus: monitorización cardiopulmonar mínimamente invasiva / Minimally invasive cardiopulmonary monitoring with the PiCCO Plus system

En los pacientes hemodinámicamente inestables oseveramente hipoxémicos ingresados en una unidad decríticos, estaría indicada la inserción de un catéter venosocentral y un catéter arterial. En este contexto, lamonitorización cardiorrespiratoria por termodilucióntranspulmonar (TDTP) puede considerarse mínimamenteinvasiva, ya que sólo requiere de un catéter arterial determodilución, de un catéter venoso central y de unmonitor específico (PiCCO plus, Pulsion Medical Systems®, Munich, Alemania).En pacientes con inestabilidad hemodinámica, laTDTP permite la evaluación simultánea y en pocosminutos del gasto cardiaco, precarga, función cardiaca yla predicción de la respuesta al volumen. Además es unatécnica que puede ser realizada por cualquier profesionalsanitario.En pacientes hipoxémicos, la TDTP identifica el edemapulmonar que podría beneficiarse de balances hídricosnegativos, evalúa la permeabilidad vascular pulmonar,facilita la comprensión de los mecanismosfisiopatológicos de la hipoxemia y predice los posiblesefectos hemodinámicos deletéreos de la PEEP (AU)

Insertion of a central venous catheter and an arterialcatheter would be indicated in hemodynamicallyunstable or severely hypoxic patients in critical careunits. In this setting, cardiorespiratory monitoring bytranspulmonary thermodilution (TPTD) can beconsidered minimally invasive given that only a singlearterial thermodilution catheter and a single centralvenous catheter are required to be connected to a specificmonitor (the PiCCO Plus, Pulsion Medical Systems,Munich, Germany). TDTP simultaneously measurescardiac output, preloading, and cardiac function inhemodynamically unstable patients and predicts theresponse to volume. The technique can be managed byany health care professional. In hypoxic patients, TDTPidentifies cases of pulmonary edema that might benefitfrom a negative fluid balance, evaluates pulmonaryvascular permeability, facilitates our understanding ofpathophysiologic mechanisms of hypoxemia, and predictsthe likelihood of deleterious hemodynamic effects ofpositive end-expiratory pressures (AU)

Hiperoxia en anestesia / No disponible

No disponible

Pasado, presente y futuro del catéter de arteria pulmonar / No disponible

No disponible