Carey M Suehs

An Increase in Aortic Blood Flow after an Infusion of 100 ml Colloid over 1 Minute Can Predict Fluid Responsiveness The Mini-fluid Challenge Study

Background: Predicting fluid responsiveness remains a difficult question in hemodynamically unstable patients. The authors objective was to test whether noninvasive assessment by transthoracic echocardiography of subaortic velocity time index (VTI) variation after a low volume of fluid infusion (100 ml hydroxyethyl starch) can predict fluid responsiveness. Methods: Thirty-nine critically ill ventilated and sedated patients with acute circulatory failure were prospectively studied. Subaortic VTI was measured by transthoracic echocardiography before fluid infusion (baseline), after 100 ml hydroxyethyl starch infusion over 1 min, and after an additional infusion of 400 ml hydroxyethyl starch over 14 min. The authors measured the variation of VTI after 100 ml fluid (&Dgr;VTI100) for each patient. Receiver operating characteristic curves were generated for (&Dgr;VTI100). When available, receiver operating characteristic curves also were generated for pulse pressure variation and central venous pressure. Results: After 500 ml volume expansion, VTI increased ≥ 15% in 21 patients (54%) defined as responders. &Dgr;VTI100 ≥ 10% predicted fluid responsiveness with a sensitivity and specificity of 95% and 78%, respectively. The area under the receiver operating characteristic curves of &Dgr;VTI100 was 0.92 (95% CI: 0.78–0.98). In 29 patients, pulse pressure variation and central venous pressure also were available. In this subgroup of patients, the area under the receiver operating characteristic curves for &Dgr;VTI100, pulse pressure variation, and central venous pressure were 0.90 (95% CI: 0.74–0.98, P < 0.05), 0.55 (95% CI: 0.35–0.73, NS), and 0.61 (95% CI: 0.41–0.79, NS), respectively. Conclusion: In patients with low volume mechanical ventilation and acute circulatory failure, &Dgr;VTI100 accurately predicts fluid responsiveness.

Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock.

IntroductionThe causative role of new hydroxyethyl starch (HES 130/0.4) in renal dysfunction frequency (a > 50% increase in serum creatinine or need for renal replacement therapy (RRT)) remains debated. Using the database of a multicenter study focusing on patients with severe sepsis and septic shock, the present study aimed at identifying factors associated with the occurrence of renal dysfunction.MethodsAmong the 435 patients in a multicenter study of patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 patients surviving after 24 hour, without a history of renal failure were included. Factors associated with renal dysfunction and RRT were isolated using a multivariate analysis with logistic regression.ResultsRenal dysfunction was reported in 117 (33%) patients. Ninety patients required RRT. Among study participants, 379 (98%) were administered fluids in the first 24 hours of management: HES 130/0.4 only (n = 39), crystalloids only (n = 63), or both HES 130/0.4 and crystalloids (n = 276). RRT was independently associated with the need for vasopressors and the baseline value of serum creatinine in the first 24 hours. Multivariate analysis indicated that male gender, SAPS II score, being a surgical patient, lack of decrease in SOFA score during the first 24 hours, and the interventional period of the study were independently associated with renal dysfunction. Mortality increased in the presence of renal dysfunction (48% versus 24%, P < 0.01).ConclusionsDespite being used in more than 80% of patients with severe sepsis and/or septic shock, the administration of HES 130/0.4 in the first 24 hours of management was not associated with the occurrence of renal dysfunction.

Impact of psychological factors on the health-related quality of life of patients treated for pulmonary arterial hypertension

OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare and life-threatening disease well-marked by under diagnosis, delayed diagnosis and atypical treatments. Few data are available on the quality of life (QoL) and psychosocial characteristics of patients with PAH. Our aim is to describe the impact of psychological factors on the health-related quality of life (HRQoL) of treated PAH patients in a cross-sectional study. METHODS Consecutive patients presenting at our Competency Centre for PAH were recruited. The aetiology, New York Heart Association (NYHA) stage, haemodynamics, 6-min walk distance (6MWD), delta SPO2 (Pulse oximeter oxygen saturation; baseline lowest value during 6-min walk test (6MWT), current treatments and psychological history were recorded. HRQoL, anxiety, depression and coping strategies were explored using self-administered questionnaires (SF-36, HADS, STAI-Y, CHIP and WCC). RESULTS A total of 55 patients were included. The HRQoL of PAH patients was poor with altered results on several scales. Anxiety and depression were high and coping was focused on medical information strategies. Multivariate analysis indicated a positive relationship between 6MWD and the Physical Composite Score for QoL (p=0.004), as well as a negative relationship between delta SPO2 and the Mental Composite Score (p=0.02), irrespective of other known prognostic factors (such as haemodynamics at right heart catheterization). Depression and Trait-Anxiety were associated with a lower physical (p=0.001) and mental (p<0.001) QoL, respectively. CONCLUSIONS Psychological factors impact the HRQoL of treated patients. A longitudinal and qualitative study should refine these results. TRIAL REGISTRATION Clinical trial N°: NCT01380054.

The feasibility of a mandibular movement test as a screening tool for polysomnography candidates

Sleep apnoea syndrome (SAS) is a common sleep disorder with a prevalence ranging from 5.9% to 79.2% in the European general population over 40 years of age, depending on the clinical symptoms and apnoea hypopnoea scoring criteria used [1]. Despite its frequency, the fact that it is a significant risk factor for many common diseases, and a recent meta-analysis demonstrating that available treatments are effective [2], SAS remains underdiagnosed. Mandibular movement tests have demonstrated potential as screening tools for polysomnography candidates http://ow.ly/iu2430fZk2u

Mortality: a neglected outcome in OCS-treated severe asthma

Severe asthma, especially if associated with a T2 phenotype, often responds well to new emerging therapies, which have led to a reduction in the use of systemic oral corticosteroids (OCS) [1]. However, OCS-dependent patients still exist and are affected by the well-known (and potentially severe) side effects of such dependency. Longitudinal data that document the outcomes, including death, for these patients are lacking [2]. Here, we present our findings from a long-term severe asthma cohort, which indicate that mortality is a critical issue for these patients. Findings from a long-term severe asthma cohort indicate mortality is a critical issue for OCS-dependent patients http://ow.ly/rO8e30fZrPo