Browsing by Author "Bakker J."

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    Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients
    (W.B. Saunders, 2022) Valenzuela E.D.; Gonzalez A.; Rovegno M.; Ramirez J.; Hernandez G.; Bruhn A.; Bakker J.; Mercado P.; Aguilera J.; Pairumani R.; Petruska E.; Morales F.; Araya C.; Medel J.N.; Ugalde D.; Eisen D.; Montoya J.; Slama M.
    © 2022 Elsevier Inc.Purpose: To evaluate cardiac function in mechanically ventilated patients with COVID-19. Materials and methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation. Results: 140 patients aged 57 ± 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5–6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction <45%). In the multivariate analysis acute cor pulmonale and PaO2/FiO2 ratio were independent predictors of ICU mortality. Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality.
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    Correction: Direct assessment of microcirculation in shock: a randomized-controlled multicenter study (Intensive Care Medicine, (2023), 49, 6, (645-655), 10.1007/s00134-023-07098-5)
    (2023) Bruno R.R.; Wollborn J.; Fengler K.; Flick M.; Wunder C.; Allgauer S.; Thiele H.; Schemmelmann M.; Hornemann J.; Moecke H.M.E.; Demirtas F.; Palici L.; Franz M.; Saugel B.; Kattan E.; De Backer D.; Bakker J.; Hernandez G.; Kelm M.; Jung C.
    © 2023, The Author(s).In this article the author Marcus Franz has been mistakenly affiliated with the Erasmus MC University Medical Center, Rotterdam, The Netherlands. He is only affiliated with the “Department of Internal Medicine I, University Hospital Jena, Jena, Germany”. The original article has been corrected. The Authors apologize for this mistake.
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    Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
    (2022) Kattan E.; Castro R.; Hernandez G.; Bakker J.; Estenssoro E.; Ospina-Tascon G.A.; Cavalcanti A.B.; De Backer D.; Vieillard-Baron A.; Teboul J.-L.
    © 2022 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.Background: Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. Methods: The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. Conclusions: If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.