Browsing by Author "Scheeren, Thomas W. L."
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- ItemCurrent use of inotropes in circulatory shock(2021) Scheeren, Thomas W. L.; Bakker, Jan; Hernández P., Glenn; Kaufmann, Thomas; Annane, Djillali; Asfar, Pierre; Boerma, E. Christiaan; Cecconi, Maurizio; Chew, Michelle S.; Cholley, BernardAbstract Background Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.
- ItemCurrent 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
- ItemEffective 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-LouisHemodynamic 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.
- ItemRed Blood Cell Transfusion in the Intensive Care Unit(2023) Raasveld, Senta Jorinde; de Bruin, Sanne; Reuland, Merijn C.; Van den Oord, Claudia; Schenk, Jimmy; Aubron, Cecile; Bakker, Jan; Cecconi, Maurizio; Feldheiser, Aarne; Meier, Jens; Mueller, Marcella C. A.; Scheeren, Thomas W. L.; Mcquilten, Zoe; Flint, Andrew; Hamid, Tarikul; Piagnerelli, Michael; Tomic Mahecic, Tina; Benes, Jan; Russell, Lene; Aguirre-Bermeo, Hernan; Triantafyllopoulou, Konstantina; Chantziara, Vasiliki; Gurjar, Mohan; Myatra, Sheila Nainan; Pota, Vincenzo; Elhadi, Muhammed; Gawda, Ryszard; Mourisco, Mafalda; Lance, Marcus; Neskovic, Vojislava; Podbregar, Matej; Llau, Juan V.; Quintana-Diaz, Manual; Cronhjort, Maria; Pfortmueller, Carmen A.; Yapici, Nihan; Nielsen, Nathan D.; Shah, Akshay; de Grooth, Harm-Jan; Vlaar, Alexander P. J.; InPUT Study GrpImportance Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice. Objective To evaluate and describe ICU RBC transfusion practices worldwide. Design, Setting, and Participants International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks. Exposure ICU stay. Main Outcomes and Measures The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused. Results Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL. Conclusions and Relevance RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.