Browsing by Author "Hamzaoui, Olfa"

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    Ability of diastolic arterial pressure to better characterize the severity of septic shock when adjusted for heart rate and norepinephrine dose
    (2025) Goury, Antoine; Djerada, Zoubir; Hernández P., Glenn; Kattan Tala, Eduardo José; Griffon, Romain; Ospina-Tascon, Gustavo; Bakker, Jan; Teboul, Jean-Louis; Hamzaoui, Olfa
    Background Septic shock is commonly associated with reduction in vasomotor tone, mainly due to vascular hyporesponsiveness to norepinephrine (NE). Although the diastolic arterial pressure (DAP)/heart rate (HR) ratio reflects vasomotor tone, it cannot be a reliable index of vascular responsiveness to NE (VNERi). We hypothesized that adjusting DAP/HR for the NE dose could yield a VNERi value (VNERi = DAP/(NE dose x HR)), knowledge of which can help guiding therapeutic strategies in cases of persistent hypotension despite NE (e.g., increasing NE doses vs. introducing additional vasopressors). For our hypothesis be valid, at least VNERi should demonstrate a stronger association with patient outcome than DAP, DAP/HR or mean arterial pressure (MAP)/NE dose, a global marker of NE responsiveness. Methods We conducted a post-hoc analysis of the ANDROMEDA-SHOCK database. Hemodynamic variables and initial NE doses were recorded at the randomization time-point, within 4 h of septic shock diagnosis. NE doses were expressed in µg/kg/min (using the bitartrate NE formulation). A multivariate model was employed to compare the associations between these variables and key clinical outcomes, including in-hospital mortality, numbers of vasopressor-free days and of renal replacement therapy (RRT)-free days up to day 28. Results The ANDROMEDA-SHOCK database included 424 patients with septic shock receiving NE. The median DAP was 52 mmHg [IQR: 45–50] and the median NE dose at inclusion was 0.2 µg/kg/min [IQR: 01-0.4]. In-hospital mortality was 43%. VNERi demonstrated the strongest association with in-hospital mortality compared to DAP, DAP/HR, and MAP/NE dose, emerging as the most significant covariate in the multivariate model. Similar findings were found for the associations with numbers of vasopressor-free days and RRT-free days up to day 28. The model revealed an inverted J-shaped relationship between in-hospital mortality and VNERi, with a nadir point at 6.7, below which mortality increased. Conclusions In patients receiving NE during early septic shock, VNERi demonstrated the strongest association with outcome compared to DAP, DAP/HR, and MAP/NE dose. Due to its physiological basis and robust association with outcomes, VNERi may serve as a valuable bedside marker of the vascular responsiveness to NE. This index could potentially be integrated into decision-making of early septic shock.
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    Consistency of data reporting in fluid responsiveness studies in the critically ill setting: the CODEFIRE consensus from the Cardiovascular Dynamic section of the European Society of Intensive Care Medicine
    (2024) Messina, Antonio; Chew, Michelle S.; Poole, Daniele; Calabro, Lorenzo; De Backer, Daniel; Donadello, Katia; Hernandez, Glenn; Hamzaoui, Olfa; Jozwiak, Mathieu; Lai, Christopher; Malbrain, Manu L. N. G.; Mallat, Jihad; Myatra, Sheyla Nainan; Muller, Laurent; Ospina-Tascon, Gustavo; Pinsky, Michael R.; Preau, Sebastian; Saugel, Bernd; Teboul, Jean-Louis; Cecconi, Maurizio; Monnet, Xavier
    PurposeTo provide consensus recommendations regarding hemodynamic data reporting in studies investigating fluid responsiveness and fluid challenge (FC) use in the intensive care unit (ICU).MethodsThe Executive Committee of the European Society of Intensive Care Medicine (ESICM) commissioned and supervised the project. A panel of 18 international experts and a methodologist identified main domains and items from a systematic literature, plus 2 ancillary domains. A three-step Delphi process based on an iterative approach was used to obtain the final consensus. In the Delphi 1 and 2, the items were selected with strong (>= 80% of votes) or week agreement (70-80% of votes), while the Delphi 3 generated recommended (>= 90% of votes) or suggested (80-90% of votes) items (RI and SI, respectively).ResultsWe identified 5 main domains initially including 117 items and the consensus finally resulted in 52 recommendations or suggestions: 18 RIs and 2 SIs statements were obtained for the domain "ICU admission", 11 RIs and 1 SI for the domain "mechanical ventilation", 5 RIs for the domain "reason for giving a FC", 8 RIs for the domain pre- and post-FC "hemodynamic data", and 7 RIs for the domain "pre-FC infused drugs". We had no consensus on the use of echocardiography, strong agreement regarding the volume (4 ml/kg) and the reference variable (cardiac output), while weak on administration rate (within 10 min) of FC in this setting.ConclusionThis consensus found 5 main domains and provided 52 recommendations for data reporting in studies investigating fluid responsiveness in ICU patients.
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    Current use of vasopressors in septic shock
    (2019) Scheeren, Thomas W. L.; Bakker, Jan; Backer, Daniel de; Annane, Djillali; Asfar, Pierre; Boerma, E. Christiaan; Cecconi, Maurizio; Dubin, Arnaldo; Dünser, Martin W.; Duranteau, Jacques; Gordon, Anthony C.; Hamzaoui, Olfa; Hernández P., Glenn; Leone, Marc; Levy, Bruno; Martin, Claude; Mebazaa, Alexandre; Monnet, Xavier; Morelli, Andrea; Payen, Didier; Pearse, Rupert; Pinsky, Michael R.; Radermacher, Peter; Reuter, Daniel; Saugel, Bernd; Sakr, Yasser; Singer, Mervyn; Squara, Pierre; Vieillard‑Baron, Antoine; Vignon, Philippe; Vistisen, Simon T.; Horst, Iwan C. C. van der; Vincent, Jean‑Louis; Tebou, Jean‑Louis
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    Effective hemodynamic monitoring
    (2022) Pinsky, Michael R.; Cecconi, Maurizio; Chew, Michelle S.; De Backer, Daniel; Douglas, Ivor; Edwards, Mark; Hamzaoui, Olfa; Hernández P., Glenn; Martin, Greg; Monnet, Xavier; Saugel, Bernd; Scheeren, Thomas W. L.; Teboul, Jean-Louis; Vincent, Jean-Louis
    Hemodynamic monitoring is the centerpiece of patient monitoring in acute care settings. Its effectiveness in terms of improved patient outcomes is difficult to quantify. This review focused on effectiveness of monitoring-linked resuscitation strategies from: (1) process-specific monitoring that allows for non-specific prevention of new onset cardiovascular insufficiency (CVI) in perioperative care. Such goal-directed therapy is associated with decreased perioperative complications and length of stay in high-risk surgery patients. (2) Patient-specific personalized resuscitation approaches for CVI. These approaches including dynamic measures to define volume responsiveness and vasomotor tone, limiting less fluid administration and vasopressor duration, reduced length of care. (3) Hemodynamic monitoring to predict future CVI using machine learning approaches. These approaches presently focus on predicting hypotension. Future clinical trials assessing hemodynamic monitoring need to focus on process-specific monitoring based on modifying therapeutic interventions known to improve patient-centered outcomes.
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    Pathophysiology of fuid administration in critically ill patients
    (2022) Messina, Antonio; Bakker, Jan; Chew, Michelle; De Backer, Daniel; Hamzaoui, Olfa; Hernández P., Glenn; Myatra, Sheila N.; Monnet, Xavier; Ostermann, Marlies; Pinsky, Michael; Teboul, Jean-Louis; Cecconi, Maurizio
    Fluid administration is a cornerstone of treatment of critically ill patients. The aim of this review is to reappraise the pathophysiology of fluid therapy, considering the mechanisms related to the interplay of flow and pressure variables, the systemic response to the shock syndrome, the effects of different types of fluids administered and the concept of preload dependency responsiveness. In this context, the relationship between preload, stroke volume (SV) and fluid administration is that the volume infused has to be large enough to increase the driving pressure for venous return, and that the resulting increase in end-diastolic volume produces an increase in SV only if both ventricles are operating on the steep part of the curve. As a consequence, fluids should be given as drugs and, accordingly, the dose and the rate of administration impact on the final outcome. Titrating fluid therapy in terms of overall volume infused but also considering the type of fluid used is a key component of fluid resuscitation. A single, reliable, and feasible physiological or biochemical parameter to define the balance between the changes in SV and oxygen delivery (i.e., coupling “macro” and “micro” circulation) is still not available, making the diagnosis of acute circulatory dysfunction primarily clinical.