Browsing by Author "Monnet, Xavier"

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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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    Fluid challenge in critically ill patients receiving haemodynamic monitoring : a systematic review and comparison of two decades
    (2022) Messina, Antonio; Calabrò, Lorenzo; Pugliese, Luca; Lulja, Aulona; Sopuch, Alexandra; Rosalba, Daniela; Morenghi, Emanuela; Hernández P., Glenn; Monnet, Xavier; Cecconi, Maurizio
    Introduction: Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge characteristics in intensive care unit (ICU) patients receiving haemodynamic monitoring and considered two decades: 2000–2010 and 2011–2021. Methods: We assessed research studies and collected data regarding study setting, patient population, fluid challenge characteristics, and monitoring. MEDLINE, Embase, and Cochrane search engines were used. A fluid challenge was defined as an infusion of a definite quantity of fluid (expressed as a volume in mL or ml/kg) in a fixed time (expressed in minutes), whose outcome was defined as a change in predefined haemodynamic variables above a predetermined threshold. Results: We included 124 studies, 32 (25.8%) published in 2000–2010 and 92 (74.2%) in 2011–2021, overall enrolling 6,086 patients, who presented sepsis/septic shock in 50.6% of cases. The fluid challenge usually consisted of 500 mL (76.6%) of crystalloids (56.6%) infused with a rate of 25 mL/min. Fluid responsiveness was usually defined by a cardiac output/index (CO/CI) increase ≥ 15% (70.9%). The infusion time was quicker (15 min vs 30 min), and crystalloids were more frequent in the 2011–2021 compared to the 2000–2010 period. Conclusions: In the literature, fluid challenges are usually performed by infusing 500 mL of crystalloids bolus in less than 20 min. A positive fluid challenge response, reported in 52% of ICU patients, is generally defined by a CO/CI increase ≥ 15%. Compared to the 2000–2010 decade, in 2011–2021 the infusion time of the fluid challenge was shorter, and crystalloids were more frequently used.
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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.