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Article: Monitorage hémodynamique du choc cardiogénique. Hemodynamic monitoring in cardiogenic shock

Beurton, Alexandra / Le Stang, Valentine

2022 Volume 31, Issue 3, Page(s) 203

Language	French
Document type	Article
ZDB-ID	2870987-1
ISSN	2496-6142
Database	Current Contents Medicine

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Zs.A 4839: Show issues

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Article: The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists.

Hermann, Bertrand / Benghanem, Sarah / Jouan, Youenn / Lafarge, Antoine / Beurton, Alexandra

Annals of intensive care

2023 Volume 13, Issue 1, Page(s) 28

Abstract: Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience ... ...

Abstract	Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
Language	English
Publishing date	2023-04-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-023-01118-9
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Passive leg raising test in patients with intra-abdominal hypertension: do not throw it.

Beurton, Alexandra / Teboul, Jean-Louis / Monnet, Xavier

Annals of translational medicine

2020 Volume 8, Issue 12, Page(s) 806

Language	English
Publishing date	2020-07-10
Publishing country	China
Document type	Journal Article ; Comment
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm.2020.03.220
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Article ; Online: Sensory interventions to relieve dyspnoea in critically ill mechanically ventilated patients.

Bureau, Côme / Niérat, Marie-Cécile / Decavèle, Maxens / Rivals, Isabelle / Dangers, Laurence / Beurton, Alexandra / Virolle, Sara / Deleris, Robin / Delemazure, Julie / Mayaux, Julien / Morélot-Panzini, Capucine / Dres, Martin / Similowski, Thomas / Demoule, Alexandre

The European respiratory journal

2024 Volume 63, Issue 1

Abstract: Background: In critically ill patients receiving mechanical ventilation, dyspnoea is frequent, severe and associated with an increased risk of neuropsychological sequelae. We evaluated the efficacy of sensory interventions targeting the brain rather ... ...

Abstract	Background: In critically ill patients receiving mechanical ventilation, dyspnoea is frequent, severe and associated with an increased risk of neuropsychological sequelae. We evaluated the efficacy of sensory interventions targeting the brain rather than the respiratory system to relieve dyspnoea in mechanically ventilated patients. Methods: Patients receiving mechanical ventilation for ≥48 h and reporting dyspnoea (unidimensional dyspnoea visual analogue scale (Dyspnoea-VAS)) first underwent increased pressure support and then, in random order, auditory stimulation (relaxing music Results: We included 46 patients (tracheotomy or intubation n=37; noninvasive ventilation n=9). Increasing pressure support decreased Dyspnoea-VAS by median 40 mm (p<0.001). Exposure to music decreased Dyspnoea-VAS compared with exposure to pink noise by median 40 mm (p<0.001). Exposure to facial air flux decreased Dyspnoea-VAS compared with limb air flux by median 30 mm (p<0.001). Increasing pressure support, but not music exposure and facial air flux, reduced Conclusions: In mechanically ventilated patients, sensory interventions can modulate the processing of respiratory signals by the brain irrespective of the intensity of the neural drive to breathe. It should therefore be possible to alleviate dyspnoea without resorting to pharmacological interventions or having to infringe the constraints of mechanical ventilation lung protection strategies by increasing ventilatory support.
MeSH term(s)	Humans ; Respiration, Artificial ; Critical Illness ; Dyspnea/therapy ; Positive-Pressure Respiration ; Noninvasive Ventilation
Language	English
Publishing date	2024-01-18
Publishing country	England
Document type	Journal Article
ZDB-ID	639359-7
ISSN	1399-3003 ; 0903-1936
ISSN (online)	1399-3003
ISSN	0903-1936
DOI	10.1183/13993003.02215-2022
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2322: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 292: Show issues

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Article ; Online: Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review.

Beurton, Alexandra / Kooistra, Emma J / De Jong, Audrey / Schiffl, Helmut / Jourdain, Mercedes / Garcia, Bruno / Vimpère, Damien / Jaber, Samir / Pickkers, Peter / Papazian, Laurent

Current obesity reports

2024

Abstract: Purpose of review: Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, ...

Abstract	Purpose of review: Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. Recent findings: The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2162-4968
ISSN (online)	2162-4968
DOI	10.1007/s13679-024-00562-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Transpulmonary thermodilution techniques in the haemodynamically unstable patient.

Beurton, Alexandra / Teboul, Jean-Louis / Monnet, Xavier

Current opinion in critical care

2019 Volume 25, Issue 3, Page(s) 273–279

Abstract: Purpose of review: Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic ... ...

Abstract	Purpose of review: Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique. Recent findings: Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery catheter. The advantage of calibrating the pulse contour analysis, as it is allowed by TPTD indices, is clearly established over uncalibrated devices. The greatest advantage of TPTD is to measure extravascular lung water and pulmonary permeability, which may be useful to diagnose acute respiratory distress syndrome and manage fluid therapy in various critical diseases. It also allows a rapid detection of left ventricular systolic failure. The information it provides must be considered complementary to that provided by echocardiography. Summary: TPTD provides several indices that may help in making decisions during the therapeutic management of haemodynamically unstable patients. It should be used for the most critically ill patients, whose management requires a reliable, precise and holistic view of the cardiopulmonary condition.
MeSH term(s)	Cardiac Output ; Catheterization, Swan-Ganz ; Extravascular Lung Water ; Hemodynamics ; Humans ; Thermodilution
Language	English
Publishing date	2019-03-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000608
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 4999: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Changes in the Plethysmographic Perfusion Index During an End-Expiratory Occlusion Detect a Positive Passive Leg Raising Test.

Beurton, Alexandra / Gavelli, Francesco / Teboul, Jean-Louis / De Vita, Nello / Monnet, Xavier

Critical care medicine

2021 Volume 49, Issue 2, Page(s) e151–e160

Abstract: Objectives: The end-expiratory occlusion test for assessing preload responsiveness consists in interrupting mechanical ventilation for 15 seconds at end-expiration and measuring the cardiac index changes. The perfusion index is the ratio between the ... ...

Abstract	Objectives: The end-expiratory occlusion test for assessing preload responsiveness consists in interrupting mechanical ventilation for 15 seconds at end-expiration and measuring the cardiac index changes. The perfusion index is the ratio between the pulsatile and the nonpulsatile portions of the plethysmography signal and is, in part, determined by stroke volume. We tested whether the end-expiratory occlusion-induced changes in perfusion index could detect a positive passive leg raising test, suggesting preload responsiveness. Design: Observational study. Setting: Medical ICU. Patients: Thirty-one ventilated patients without atrial fibrillation. Interventions: We measured perfusion index (Radical-7 device; Masimo Corp., Irvine, CA) and cardiac index (PiCCO2; Pulsion Medical Systems, Feldkirchen, Germany) before and during a passive leg raising test and a 15-second end-expiratory occlusion. Measurements and main results: In 19 patients with a positive passive leg raising test (increase in cardiac index ≥ 10%), compared to the baseline value and expressed as a relative change, passive leg raising increased cardiac index and perfusion index by 17% ± 7% and 49% ± 23%, respectively, In these patients, end-expiratory occlusion increased cardiac index and perfusion index by 6% ± 2% and 11% ± 8%, respectively. In the 12 patients with a negative passive leg raising test, perfusion index did not significantly change during passive leg raising and end-expiratory occlusion. Relative changes in perfusion index and cardiac index observed during all interventions were significantly correlated (r = 0.83). An end-expiratory occlusion-induced relative increase in perfusion index greater than or equal to 2.5% ([perfusion index during end-expiratory occlusion-perfusion index at baseline]/perfusion index at baseline × 100) detected a positive passive leg raising test with an area under the receiver operating characteristic curve of 0.95 ± 0.03. This threshold is larger than the least significant change observed for perfusion index (1.62% ± 0.80%). Conclusions: Perfusion index could be used as a reliable surrogate of cardiac index for performing the end-expiratory occlusion test. Confirming previous results, the relative changes in perfusion index also reliably detected a positive passive leg raising test.
MeSH term(s)	Aged ; Cardiac Output ; Female ; Hemodynamics/physiology ; Humans ; Intensive Care Units ; Leg/blood supply ; Male ; Middle Aged ; Perfusion Index/methods ; Plethysmography ; Positive-Pressure Respiration/methods ; Posture/physiology ; Respiratory Distress Syndrome/therapy
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000004768
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1261: Show issues

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Article ; Online: Limiting positive end-expiratory pressure to protect renal function in SARS-CoV-2 critically ill patients.

Beurton, Alexandra / Haudebourg, Luc / Simon-Tillaux, Noémie / Demoule, Alexandre / Dres, Martin

Journal of critical care

2020 Volume 59, Page(s) 191–193

Keywords	covid19
Language	English
Publishing date	2020-07-10
Publishing country	United States
Document type	Letter
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2020.07.008
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2152: Show issues

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Article: Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study.

Penaud, Victor / Vieille, Thibault / Urbina, Tomas / Bonny, Vincent / Gabarre, Paul / Missri, Louai / Gasperment, Maxime / Baudel, Jean-Luc / Carbonell, Nicolas / Beurton, Alexandra / Chaibi, Sayma / Retbi, Aurélia / Fartoukh, Muriel / Piton, Gaël / Guidet, Bertrand / Maury, Eric / Ait-Oufella, Hafid / Joffre, Jérémie

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 28

Abstract: Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication ... ...

Abstract	Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. Methods: We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. Results: Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97). Conclusions: Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
Language	English
Publishing date	2024-02-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-024-01250-0
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Article ; Online: The increase in cardiac output induced by a decrease in positive end-expiratory pressure reliably detects volume responsiveness: the PEEP-test study.

Lai, Christopher / Shi, Rui / Beurton, Alexandra / Moretto, Francesca / Ayed, Soufia / Fage, Nicolas / Gavelli, Francesco / Pavot, Arthur / Dres, Martin / Teboul, Jean-Louis / Monnet, Xavier

Critical care (London, England)

2023 Volume 27, Issue 1, Page(s) 136

Abstract: Background: In patients on mechanical ventilation, positive end-expiratory pressure (PEEP) can decrease cardiac output through a decrease in cardiac preload and/or an increase in right ventricular afterload. Increase in central blood volume by fluid ... ...

Abstract	Background: In patients on mechanical ventilation, positive end-expiratory pressure (PEEP) can decrease cardiac output through a decrease in cardiac preload and/or an increase in right ventricular afterload. Increase in central blood volume by fluid administration or passive leg raising (PLR) may reverse these phenomena through an increase in cardiac preload and/or a reopening of closed lung microvessels. We hypothesized that a transient decrease in PEEP (PEEP-test) may be used as a test to detect volume responsiveness. Methods: Mechanically ventilated patients with PEEP ≥ 10 cmH Results: We enrolled 64 patients among whom 31 were volume responsive. The median increase in CI during PLR was 14% (11-16%). The median PEEP at baseline was 12 (10-15) cmH Conclusions: A CI increase > 8.6% during a PEEP-test, which consists in reducing PEEP to 5 cmH
MeSH term(s)	Humans ; Blood Volume/physiology ; Cardiac Output/physiology ; Diagnostic Techniques, Cardiovascular ; Diagnostic Techniques, Respiratory System ; Fluid Therapy/methods ; Heart/physiopathology ; Hemodynamics ; Positive-Pressure Respiration/adverse effects ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; ROC Curve
Language	English
Publishing date	2023-04-09
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-023-04424-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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