a prospective study to determine the value of transthoracic echocardiography (TTE) in assessing h... more a prospective study to determine the value of transthoracic echocardiography (TTE) in assessing hypotensive patients in a medical/surgical Intensive care Unit (ICU).a 16-bed medical/surgical ICU.patients with hypotension were studied (systolic arterial pressure < 90 mmHg or mean arterial pressure < 60 mmHg, non responsive to fluid therapy in a 30-minute period). TTE was aimed to: exclude severe cardiac dysfunction(abnormalities requiring immediate therapeutic decision); to evaluate other non severe cardiac alterations; to determine cardiac index (CI) and analyse inferior vena cava (IVC).Two hundred eight patients were studied, and 198 enrolled (4.5% of impossible examinations), with a mean age 63.4 +/- 16.2 years, 129 male, APACHE II score 30.1 +/- 9.9, SAPS II 68.8 +/- 20.5, SOFA 11.6 +/- 3.8, MODS 10.9 +/- 3.9. Mortality was 51% (n=101) and 168 (82.2%) patients were under mechanical ventilation. Forty four patients (44.4%) presented cardiac abnormalities, 28 of whom (14%) se...
Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéri... more Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéria pulmonar e não invasivas utilizando a ecocardiografia transtorácica (ETT) de 4 parâmetros hemodinâmicos: débito cardíaco (DC), pressão de encravamento da artéria pulmonar (PCP), pressão venosa central (PVC), e pressão sistólica da artéria pulmonar (PSAP). Material e Métodos: estudo prospectivo numa Unidade de Cuidados Intensivos (UCI) médico-cirurgica. Foram estudados 41 doentes em pós-operatório de transplante hepático, nos quais o DC, a PCP, a PVC e a PSAP foram obtidos em simultâneo por 2 observadores independentes, utilizando a ETT e o cateterismo invasivo da artéria pulmonar. Para a quantificação por ETT dos parâmetros foram utilizadas fórmulas descritas na literatura. As medições invasivas e não invasivas foram comparadas através de uma análise de correlação linear e de Bland-Altman. Resultados: Verificou-se uma boa correlação nas medições invasivas e não invasivas do DC (r=0,97)...
Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive c... more Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive care units, specially the ones with general multi-care profile. In the past few years an increasing number of patients admitted have an important cardiac component, reason why we emphasize the role of this non invasive diagnostic tool. It's easily performed, may be repeated as many times as necessary, thus providing a quick diagnosis of the disease, its repercussions and medical or surgical interventions.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1995
Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive c... more Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive care units, specially the ones with general multi-care profile. In the past few years an increasing number of patients admitted have an important cardiac component, reason why we emphasize the role of this non invasive diagnostic tool. It's easily performed, may be repeated as many times as necessary, thus providing a quick diagnosis of the disease, its repercussions and medical or surgical interventions.
RESUMO O cateter da artéria pulmonar é um instrumento de diagnóstico de utilização corrente em cu... more RESUMO O cateter da artéria pulmonar é um instrumento de diagnóstico de utilização corrente em cuidados intensivos cardiológicos e não cardiológicos. Desde a sua implementação na prática clínica, na década de 70, têm sido levantadas dúvidas sérias sobre a sua utilização e ...
Resumo O trabalho do Internista no Serviço de Urgência (SU) torna pertinente a abordagem de certo... more Resumo O trabalho do Internista no Serviço de Urgência (SU) torna pertinente a abordagem de certos temas controversos, entre os quais o da utilização adequada de fluidoterapia na sépsis. Sendo uma prática comum, em especial se a hipotensão está presente, os seus ...
The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate o... more The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.
a prospective study to determine the value of transthoracic echocardiography (TTE) in assessing h... more a prospective study to determine the value of transthoracic echocardiography (TTE) in assessing hypotensive patients in a medical/surgical Intensive care Unit (ICU).a 16-bed medical/surgical ICU.patients with hypotension were studied (systolic arterial pressure < 90 mmHg or mean arterial pressure < 60 mmHg, non responsive to fluid therapy in a 30-minute period). TTE was aimed to: exclude severe cardiac dysfunction(abnormalities requiring immediate therapeutic decision); to evaluate other non severe cardiac alterations; to determine cardiac index (CI) and analyse inferior vena cava (IVC).Two hundred eight patients were studied, and 198 enrolled (4.5% of impossible examinations), with a mean age 63.4 +/- 16.2 years, 129 male, APACHE II score 30.1 +/- 9.9, SAPS II 68.8 +/- 20.5, SOFA 11.6 +/- 3.8, MODS 10.9 +/- 3.9. Mortality was 51% (n=101) and 168 (82.2%) patients were under mechanical ventilation. Forty four patients (44.4%) presented cardiac abnormalities, 28 of whom (14%) se...
Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéri... more Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéria pulmonar e não invasivas utilizando a ecocardiografia transtorácica (ETT) de 4 parâmetros hemodinâmicos: débito cardíaco (DC), pressão de encravamento da artéria pulmonar (PCP), pressão venosa central (PVC), e pressão sistólica da artéria pulmonar (PSAP). Material e Métodos: estudo prospectivo numa Unidade de Cuidados Intensivos (UCI) médico-cirurgica. Foram estudados 41 doentes em pós-operatório de transplante hepático, nos quais o DC, a PCP, a PVC e a PSAP foram obtidos em simultâneo por 2 observadores independentes, utilizando a ETT e o cateterismo invasivo da artéria pulmonar. Para a quantificação por ETT dos parâmetros foram utilizadas fórmulas descritas na literatura. As medições invasivas e não invasivas foram comparadas através de uma análise de correlação linear e de Bland-Altman. Resultados: Verificou-se uma boa correlação nas medições invasivas e não invasivas do DC (r=0,97)...
Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive c... more Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive care units, specially the ones with general multi-care profile. In the past few years an increasing number of patients admitted have an important cardiac component, reason why we emphasize the role of this non invasive diagnostic tool. It's easily performed, may be repeated as many times as necessary, thus providing a quick diagnosis of the disease, its repercussions and medical or surgical interventions.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1995
Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive c... more Echocardiography hasn't played yet a major role in the majority of the noncardiac intensive care units, specially the ones with general multi-care profile. In the past few years an increasing number of patients admitted have an important cardiac component, reason why we emphasize the role of this non invasive diagnostic tool. It's easily performed, may be repeated as many times as necessary, thus providing a quick diagnosis of the disease, its repercussions and medical or surgical interventions.
RESUMO O cateter da artéria pulmonar é um instrumento de diagnóstico de utilização corrente em cu... more RESUMO O cateter da artéria pulmonar é um instrumento de diagnóstico de utilização corrente em cuidados intensivos cardiológicos e não cardiológicos. Desde a sua implementação na prática clínica, na década de 70, têm sido levantadas dúvidas sérias sobre a sua utilização e ...
Resumo O trabalho do Internista no Serviço de Urgência (SU) torna pertinente a abordagem de certo... more Resumo O trabalho do Internista no Serviço de Urgência (SU) torna pertinente a abordagem de certos temas controversos, entre os quais o da utilização adequada de fluidoterapia na sépsis. Sendo uma prática comum, em especial se a hipotensão está presente, os seus ...
The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate o... more The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.
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