Acute respiratory failure and echocardiographic examination

Česká verzia

Authors: M. Balík
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK a VFN, Praha
Published in the journal: Anest. intenziv. Med., 28, 2017, č. 1, s. 23-34
Category:

Summary

Acute respiratory failure, a condition frequently fraught with haemodynamic instability, is one of the most frequent reasons for admission to the intensive care ward. Obligatory questions in every patient concern the left ventricular function and assessment of the left atrial and left ventricular filling pressures. The prognosis and management of respiratory failure also depend on assessment of the right ventricular function and pulmonary circulation. A complex echo protocol is warranted to judiciously decide on the treatment strategy including optimization of the patient‘s preload, contractility, heart rate and afterload. This allows for effective treatment of respiratory disequilibrium, which can continue to be monitored by means of ultrasound. Monitoring of the lung parenchyma and pleural space enables the physician to obtain additional data supporting the echocardiography findings, assisting the decision making on the ventilation strategy, the need for bronchoscopy, pleural drainage and to determine optimal patient position including prone postitioning. The appropriateness of prescribed therapy for the acute respiratory failure management can then be monitored by bedside echocardiography and lung ultrasonography in the attempt to optimize pulmonary gas exchange without haemodynamic alteration, and also to improve the patient’s haemodynamic status without adding an unnecessary burden to the respiratory system. As the respiratory failure responds to treatment, echocardiography can then assist with weaning and termination of ventilatory support. Where the respiratory failure is critical, rapid assessment with echocardiography and chest ultrasound helps in the decision-making as to whether to proceed to extracorporeal lung assist (ECLS) support and if adopted, its optimal configuration. ECLS requires ultrasound modalities for correct indication, management and weaning of this mode of support. Echocardiographic monitoring of patients in acute respiratory failure is indispensable and an ultrasonic device should be considered essential equipment for every intensive care unit.

Keywords:
acute respiratory failure– echocardiography – ultrasonography – chest ultrasonography – intensive care – intermittent positive pressure ventilation – extracorporeal membrane oxygenation

Zdroje

1. Brun-Buisson, C., Minelli, C., Bertolini, G. et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med., 2004, 30, p. 51–61.

2. Gajic, O., Afessa, B., Thompson, B. T. et al. for the 2nd International Study of Mechanical Ventilation and ARDS-net Investigators. Prediction of death and prolonged mechanical ventilation in acute lung injury. Crit Care, 2007, 11, p. R53.

3. Pinsky, M. R., Payen, D. Functional hemodynamic monitoring. Crit Care, 2005, 9, p. 566–572.

4. Orme, R. M., Oram, M. P., McKinstry, C. E. Impact of echocardiography on patient management in the intensive care unit: an audit of district general hospital practice. Br. J. Anaesth., 2009, 102, p. 340–344.

5. ARDS Definition Task Force, Ranieri, V. M., Rubenfeld, G. D., Thompson, B. T., Ferguson, N. D., Caldwell, E., Fan, E., Camporota, L., Slutsky, A. S. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307, 23, p. 2526–2533.

6. Lang, R. M., Badano, L. P., Mor-Avi, V. et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal – Cardiovascular Imaging, 2015, 16, p. 233–271.

7. Nagueh, S. F., Appleton, C. P., Gillebert, T. C., Marino, P. N., Oh, J. K., Smiseth, O. A., Waggoner, A. D., Flachskampf, F. A., Pellikka, P. A., Evangelisa, A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur. J. Echocardiogr., 2009, 10, p. 165–193.

8. Haji, D. L., Ali, M. M., Royse, A., Canty, D. J., Clarke, S., Royse, C. F. Interatrial septum motion but not Doppler assessment predicts elevated pulmonary capillary wedge pressure in patients undergoing cardiac surgery. Anesthesiology, 2014, 121, p. 719–729.

9. Vieillard-Baron, A., Chergui, K., Augarde, R., Prin, S., Page, B., Beauchet, A. et al. Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am. J. Respir. Crit. Care Med., 2003, 168, p. 671–676.

10. Cha, J. J., Chung, H., Yoon, Y. W. et al. Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypetrophic cardiomyopathy. J. Cardiovasc. Ultrasound, 2014, 12, p. 23.

11. Boussugues, A., Blanc, P., Molenat, F., Burnet, F., Burnet, H., Habib, G., Sainty, J. M. Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit. Crit. Care Med., 2002, 30, p. 362–367.

12. Yamamoto, K., Nishimura, R. A., Chaliki, H. P., Appleton, C. P., Holmes, D. R. Jr., Redfield, M. M. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J. Am. Coll. Cardiol., 1997, 30, p. 1819–1826.

13. Vignon, P., Ait Hussain, A., Francois, B., Preaux, P. M., Pichon, N., Clavel, M., Frat, J. P., Gastinne, H. Noninvasive assessment of pulmonary artery occlusion pressure in ventilated patients: a transesophageal study. Crit. Care, 2008, 12, p. R18.

14. Vargas, F., Gruson, D., Valentino, R., Bui, H. N., Salmi, L. R., Gilleron, V., Gbikpi-Bennisan, G., Guenard, H., Hilbert, G. Transesophageal pulsed Doppler echocardiography of pulmonary venous flow to assess left ventricular filling pressure in ventilated patients with acute respiratory distress syndrome. J. Crit. Care, 2004, 19, p. 187–197.

15. Kinnaird, T. D., Thompson, C. R., Munt, B. I. The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure. J. Am. Coll. Cardiol., 2001, 37, p. 2025–2030.

16. Sohn, D. W., Song, J. M., Zo, J. H., Chai, I. H., Kim, H. S., Chun, H. G., Kim, H. C. Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J. Am. Soc. Echocardiogr., 1999, 12, p. 927–931.

17. Naughton, M. T., Rahman, M. A., Hara, K., Floras, J. S., Bradley, T. D. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation, 1995, 91, p. 1725–1731.

18. Schmitt, J. M., Vieillard-Baron, A., Augarde, R., Prin, S., Page, B., Jardin, F. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: Impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit. Care Med., 2001, 29, p. 1154–1158.

19. Jardin, F., Vieillard-Baron, A. Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med., 2007, 33, p. 444–447.

20. Haddad, F., Couture, P., Tousignant, C., Denault, A. Y. The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: I. Anatomy, Physiology, and Assessment. Anesth. Analg., 2009, 108, p. 407–421.

21. Mekontso Dessap, A., Boissier, F., Leon, R., Carreira, S., Campo, F. R., Lemaire, F., Brochard, L. Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome. Crit. Care Med., 2010, 38, p. 1786–1792.

22. Belohlavek, J., Rohn, V., Jansa, P., Tosovsky, J., Kunstyr, J., Semrad, M., Horak, J., Lips, M., Mlejnsky, F., Balik, M., Klein, A., Linhart, A., Lindner, J. Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern. J. Invasive Cardiol., 2010, 22, p. 365–369.

23. Mahjoub, Y., Pila, C., Friggeri, A. et al. Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit. Care Med., 2009, 37, p. 2570–2575.

24. Vieillard-Baron, A., Charon, C., Caille, V., Belliard, G., Page, B., Jardin, F. Prone positioning unloads the right ventricle in severe ARDS. Chest, 2007, 132, p. 1440–1446.

25. Mercat, A., Diehl, J. L., Meyer, G. et al. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit. Care Med., 1999, 27, p. 540–544.

26. Balik, M., Plasil, P., Pazout, J. et al. Ultrasound guided thoracentesis in mechanically ventilated patients. Intensive Care Med., 2006, 32, p. 318–321.

27. Lichtenstein, D., Meziere, G., Biderman, R. et al. The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med., 2000, 26, p. 1434–1440.

28. Baldi, G., Gargani, L., Abramo, A., D‘Errico, L., Caramella, D., Picano, E., Giunta, F., Forfori, F. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med., 2013, 39, p. 74–84.

29. Lichtenstein, D., Meziere, G. A., Lagoueyte, J. F., Biderman, P., Goldstein, I., Gepner, A. A-Lines and B-Lines. Lung Ultrasound as a Bedside Tool for Predicting Pulmonary Artery Occlusion Pressure in the Critically Ill. Chest, 2009, 136, p. 1014–1020.

30. Bouhemad, B., Brisson, H., Le-Guen, M., Arbelot, C., Lu, Q., Rouby, J. L. Bedside Ultrasound Assessment of Positive End-Expiratory Pressure-induced Lung Recruitment. Am. J. Respir. Crit. Care Med., 2011, 183, p. 341–347.

31. Lichtenstein, D., Meziere, G., Seitz, J. The dynamic dynam bronchogram: A Lung Ultrasound Sign of Alveolar Consolidation Ruling Out Atelectasis. Chest, 2009, 135, p. 1421–1425.

32. Nielsen, J., Østergaard, M., Kjaergaard, J., Tingleff, J., Berthelsen, P. G., Nygård, E., Larsson, A. Lung recruitment maneuver depresses central hemodynamics in patients following cardiac surgery. Intensive Care Med., 2005, 31, p. 1189–1194.

33. Gernoth, C., Wagner, G., Pelosi, P., Luecke, T. Respiratory and haemodynamic changes during decremental open lung positive end-expiratory pressure titration in patients with acute respiratory distress syndrome. Crit. Care, 2009, 13, R59.

34. Tsubo, T., Yatsu, Y., Tanabe, T., Okawa, H., Ishihara, H., Matsuki A. Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography. Crit. Care Med., 2004, 32, p. 83–87.

35. Caille, V., Amiel, J. B., Charron, C., Belliard, G., Vieillard-Baron, A., Vignon, P. Echocardiography: a help in the weaning process. Crit. Care, 2010, 14, p. R120.

36. Soummer, A., Perbet, S., Brisson, H., Arbelot, C., Constantin, J. M., Lu, Q., Rouby, J. J. Lung Ultrasound Study Group Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit. Care Med., 2012, 40, p. 2064–2072.

37. Peris, A., Lazzeri, C., Cianchi, G., Bonizzoli, M., Batacchi, S., Bernardo, P., Valente, S., Gensini, G. F. Clinical significance of echocardiography in patients supported by venous-venous extracorporeal membrane oxygenation. J. Artif. Organs, 2015, 18, p. 99–105.

38. Brechot, N., Luyt, C. E., Schmidt, M. et al. Venoarterial Extracorporeal Membrane Oxygenation Support for Refractory Cardiovascular Dysfunction During Severe Bacterial Septic Shock. Crit. Care Med., 2013, 41, p. 1616–1626.

Štítky

Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

Článek The most frequent complications associated with general anaesthesia from the patient’s point of view. Questionnaire comparative study 2007/2014

Článek Prediction of fluid responsiveness

Článok vyšiel v časopise

Anaesthesiology and Intensive Care Medicine

2017 Číslo 1

Najčítanejšie v tomto čísle