43 results on '"Sam Orde"'
Search Results
2. Right ventricular outflow tract Doppler flow analysis and pulmonary arterial coupling by transthoracic echocardiography in sepsis: a retrospective exploratory study
- Author
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Emma Maria Bowcock, Benjamin Gerhardy, Stephen Huang, and Sam Orde
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Echocardiography ,Hypertension, Pulmonary ,Sepsis ,Ventricular Dysfunction, Right ,Humans ,Pulmonary Artery ,Critical Care and Intensive Care Medicine ,Retrospective Studies - Abstract
Introduction Right ventricular (RV) and pulmonary vascular dysfunction appear to be common in sepsis. RV performance is frequently assessed in isolation, yet its close relationship to afterload means combined analysis with right ventricular outflow tract (RVOT) Doppler and RV–pulmonary arterial (RV–PA) coupling may be more informative than standard assessment techniques. Data on feasibility and utility of these parameters in sepsis are lacking and were explored in this study. Methods This is a retrospective study over a 3-year period of one-hundred and thirty-one patients admitted to ICU with sepsis who underwent transthoracic echocardiography (TTE) with RVOT pulsed wave Doppler. RVOT Doppler flow and RV–PA coupling was evaluated alongside standard measurements of RV systolic function and pulmonary pressures. RVOT Doppler analysis included assessment of pulmonary artery acceleration time (PAAT), velocity time integral and presence of notching. RV–PA coupling was assessed using tricuspid annular planar systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. Results PAAT was measurable in 106 (81%) patients, and TAPSE/PASP was measurable in 77 (73%). Seventy-three (69%) patients had a PAAT of ≤ 100 ms suggesting raised pulmonary vascular resistance (PVR) is common. RVOT flow notching occurred in 15 (14%) of patients. TRV was unable to be assessed in 24 (23%) patients where measurement of PAAT was possible. RV dysfunction (RVD) was present in 28 (26%), 26 (25%) and 36 (34%) patients if subjective assessment, TAPSE Conclusion Raised PVR and RV–PA uncoupling is seen in a significant proportion of patients with sepsis. Non-invasive assessment with TTE is feasible. The role of these parameters in assisting improved definitions of RVD, as well as their therapeutic and prognostic utility against standard parameters, deserves further investigation.
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- 2022
3. The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review
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Timothy Scully, Anthony S. McLean, Sam Orde, Stephen Huang, and Yifan Huang
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medicine.medical_specialty ,business.industry ,Septic shock ,Haemodynamic monitoring ,Thermodilution ,Fluid responsiveness ,030208 emergency & critical care medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,Shock, Septic ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030228 respiratory system ,Fluid therapy ,Internal medicine ,Cardiac output monitoring ,medicine ,Cardiology ,Fluid Therapy ,Humans ,Cardiac Output ,business - Abstract
Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.
- Published
- 2020
4. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)
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Stephen, Huang, Philippe, Vignon, Armand, Mekontso-Dessap, Ségolène, Tran, Gwenael, Prat, Michelle, Chew, Martin, Balik, Filippo, Sanfilippo, Gisele, Banauch, Fernando, Clau-Terre, Andrea, Morelli, Daniel, De Backer, Bernard, Cholley, Michel, Slama, Cyril, Charron, Marine, Goudelin, Francois, Bagate, Pierre, Bailly, Patrick-Johansson, Blixt, Paul, Masi, Bruno, Evrard, Sam, Orde, Paul, Mayo, Anthony S, McLean, Antoine, Vieillard-Baron, and Thomas, Daix
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Heart Failure ,Male ,Intensive Care Units ,Ventricular Dysfunction, Left ,Echocardiography ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,COVID-19 ,Humans ,Female ,Pulmonary Embolism ,Aged ,Retrospective Studies - Abstract
Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR 4), pulmonary embolism (OR 5) and increased PaCOAlmost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
- Published
- 2022
5. Minimum standards for ultrasound equipment in intensive care. Recommendations from CICM Ultrasound Special Interest Group
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Andrew Hilton, Sam Orde, Yang Yang, Sanjiv Vij, Cartan Costello, and Konstantin Yastrebov
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Service (business) ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Consensus Statement ,030208 emergency & critical care medicine ,030204 cardiovascular system & hematology ,Special Interest Group ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,Ultrasonography ,Quality of care ,business ,General ultrasound - Abstract
Critical care ultrasonography allows rapid bedside assessment and monitoring of severely ill patients. It provides important information on a real-time basis for patients' management and clinical decision-making, leading to improvements in delivered quality of care. Provision of this service is not possible without appropriate equipment. This document recommends minimum standards for ultrasound equipment required for use in intensive care units in Australia and New Zealand.
- Published
- 2021
6. Levels of training in critical care echocardiography in adults. Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group
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Sam Orde, Vinodh B Nanjayya, Marek Nalos, Yang Yang, Cartan Costello, Andrew Hilton, John Evans, and Konstantin Yastrebov
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medicine.medical_specialty ,Scope of practice ,Radiological and Ultrasound Technology ,business.industry ,education ,Special Interest Group ,Guidelines ,Transoesophageal echocardiography ,Intensive care unit ,law.invention ,Face-to-face ,law ,Intensive care ,Medicine ,Radiology, Nuclear Medicine and imaging ,Clinical competence ,business ,Intensive care medicine - Abstract
Critical care echocardiography (CCE) is commonly performed in many intensive care units across Australia and New Zealand (ANZ). The scope of practice ranges from Basic CCE through to Advanced CCE and includes the use of transthoracic echocardiography and transoesophageal echocardiography. Many training and qualification pathways exist with no standardisation of education goals. This document defines different levels of CCE expertise and recommends minimum training standards for each level of adult CCE in ANZ. Guidelines committee of College of Intensive Care Medicine's Ultrasound Special Interest Group held multiple face to face meetings, organised teleconferences, conducted a survey of the Fellows of the college and reviewed the international CCE training pathways prior to writing these guidelines.
- Published
- 2021
7. Audit of low tidal volume ventilation in patients with hypoxic respiratory failure in a tertiary Australian intensive care unit
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David P. Wilkins, Andrew S Lane, and Sam Orde
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ARDS ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,medicine ,Tidal Volume ,Humans ,030212 general & internal medicine ,Tidal volume ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Australia ,medicine.disease ,Intensive care unit ,Respiration, Artificial ,Confidence interval ,Intensive Care Units ,Anesthesiology and Pain Medicine ,030228 respiratory system ,Respiratory failure ,Emergency medicine ,Breathing ,business ,Respiratory Insufficiency - Abstract
A low tidal volume ventilation (LTVV) strategy improves outcomes in patients with acute respiratory distress syndrome (ARDS). Subsequently, a LTVV strategy has become the standard of care for patients receiving mechanical ventilation. This strategy is poorly adhered to within intensive care units (ICUs). A retrospective analysis was conducted of prescribed tidal volumes in mechanically ventilated patients with hypoxic respiratory failure between April 2013 and March 2017. Data collection included the establishment of a new data-entry box for patient height in March 2016, aimed at assisting the calculation of LTVV. We reviewed 836 ICU admissions, comprising 19,884 hours of ventilation. A total of 92% of admissions lacked patient height recording. When height was recorded, 54% of hours of ventilation were LTVV adherent. Non-LTVV hours for both groups involved higher tidal volumes (38%) rather than lower tidal volumes (8%). Non–LTVV-adherent hours were significantly ( P
- Published
- 2021
8. Reporting focused lung ultrasound studies in critical care. Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group
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Marek Nalos, Sam Orde, Máté Rudas, and Yang Yang
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Research opportunities ,Guidelines ,respiratory system ,Special Interest Group ,respiratory tract diseases ,Lung ultrasound ,Haemodynamic instability ,Acute care ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,business ,Intensive care medicine ,Quality assurance - Abstract
OBJECTIVE: To describe the recommended procedure and common ultrasonographic findings and present a framework for labelling, recording and reporting of images obtained during a focused lung ultrasound study. BACKGROUND: Lung ultrasound is a widely utilised point‐of‐care investigation in acute care, providing valuable diagnostic information in patients with dyspnoea or haemodynamic instability. It has a number of recognised advantages and has been incorporated into a variety of clinical algorithms. Recommendations for performing lung ultrasound and description of common artefacts are readily available; however, there is a lack of a recognised framework for labelling and reporting a lung ultrasound study. Standardised recording, labelling and reporting are important clinically, while promoting consistency, quality assurance, teaching and research opportunities. Documenting lung ultrasound also has potential medico‐legal implications. RESULTS: For focused lung ultrasound, an extended bilateral four‐quadrant approach is recommended. Acquired images and loops should be clearly labelled identifying left or right, anterior or lateral and inferior, superior or posterior locations. 2D loops should be of sufficient length to clearly demonstrate pleural sliding, complemented by M‐mode stills if required. Reports should provide information regarding the presence or absence of an intact pleural interface, the presence or absence and the size and nature of pleural collections as well as any parenchymal artefacts or consolidation, in all examined locations. It is important to use internationally accepted terminology to describe findings, and it is also recommended to conclude the report with a clear summary that can be interpreted by healthcare providers without specific training in lung ultrasound.
- Published
- 2019
9. Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?
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Sam Orde, Faraz Pathan, Michel Slama, Anthony S. McLean, and Stephen Huang
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Adult ,Male ,medicine.medical_specialty ,Contrast Media ,Coronary Artery Disease ,Critical Care and Intensive Care Medicine ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Troponin I ,medicine ,Humans ,Medical history ,Prospective Studies ,Adverse effect ,Critically ill ,Aged ,medicine.diagnostic_test ,biology ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Blood flow ,lcsh:RC86-88.9 ,Middle Aged ,Contrast ,medicine.disease ,Troponin ,Perfusion ,Intensive Care Units ,Echocardiography ,Angiography ,biology.protein ,Cardiology ,Feasibility Studies ,Female ,New South Wales ,business - Abstract
Background Diagnosis of significant coronary artery disease (CAD) and acute coronary artery occlusion in ICU can be difficult, and an inappropriate intervention is potentially harmful. Myocardial contrast perfusion echo (MCPE) examines ultrasound contrast intensity replenishment curves in individual myocardial segments measuring peak contrast intensity and slope of return as an index of myocardial blood flow (units = intensity of ultrasound per second [dB/s]). MCPE could possibly serve as a triage tool to invasive angiography by estimating blood flow in the myocardium. We sought to assess feasibility in the critically ill and if MCPE could add incremental value to the clinical acumen in predicting significant CAD. Methods This is a single-centre, prospective, observational study. Inclusion criteria were as follows: adult ICU patients with troponin I > 50 ng/L and cardiology referral being made for consideration of inpatient angiography. Exclusion criteria were as follows: poor echo windows (2 patients), known ischaemic heart disease, and contrast contraindications. Seven cardiologists and 6 intensivists blinded to outcome assessed medical history, ECG, troponin, and 2D echo images to estimate likelihood of significant CAD needing intervention (clinical acumen). Clinical acumen, quantitative MCPE, and subjective (visual) MCPE were assessed to predict significant CAD. Results Forty patients underwent MCPE analysis, 6 (15%) had significant CAD, and median 11 of 16 segments (IQR 8–13) could be imaged (68.8% [IQR 50–81]). No adverse events occurred. A significant difference was found in overall MCPE blood flow estimation between those diagnosed with significant CAD and those without (3.3 vs 2.4 dB/s, p = 0.050). A MCPE value of 2.8 dB/s had 67% sensitivity and 88% specificity in detecting significant CAD. Clinical acumen showed no association in prediction of CAD (OR 0.6, p = 0.09); however, if quantitative or visual MCPE analysis was included, a significant association occurred (OR 17.1, p = 0.01; OR 23.0, p = 0.01 respectively). Conclusions MCPE is feasible in the critically ill and shows better association with predicting significant CAD vs clinical acumen alone. MCPE adds incremental value to initial assessment of the presence of significant CAD which may help guide those who require urgent angiography.
- Published
- 2019
10. Massive Left Atrium from Severe Mitral Stenosis due to Rheumatic Heart Disease: Clinical Images Not Usually Seen in Modern Radiology and Ultrasound
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Andrew S Lane, David J. Clancy, Ian Seppelt, and Sam Orde
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medicine.medical_specialty ,Stenosis ,medicine.anatomical_structure ,Heart disease ,business.industry ,Ultrasound ,Left atrium ,medicine ,Radiology ,business ,medicine.disease - Abstract
Rheumatic heart disease is becoming far less common in the developed world, and therefore expsoure to its complications are been seen less by clinicians. With the increasing ease of world travel, patients with less commonly seen medical conditions are increasingly presenting to Hospitals requiring management of their complications. We present a case of an elderly lady who was a tourist in Australia, who presented with complications of her rheumatic heart disease, and her subsequent radiological and echocardiographic investigations were a significant surpirse for her treating clinicians.
- Published
- 2019
11. An Australian case of multisystem inflammatory syndrome in an adult during the 2021 SARS‐CoV‐2 Delta outbreak
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Sam Orde, Zoe Jennings, and Annaleise R Howard-Jones
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Mucocutaneous zone ,Outbreak ,General Medicine ,medicine.disease_cause ,Virology ,Shock (circulatory) ,Medicine ,medicine.symptom ,business ,Coronavirus - Abstract
We report, to our knowledge, the first Australian case of multisystem inflammatory syndrome in adults, a rare but severe systemic inflammatory syndrome occurring 4-6 weeks after COVID-19 infection. Clinicians should be aware of this syndrome in children or adults with shock, mucocutaneous and/or gastrointestinal features, even without prior symptomatic COVID-19 infection.
- Published
- 2021
12. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies
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Andrea Morelli, Carlos Corredor, N. Fletcher, Michelle S Chew, Michel Slama, Guillaume Geri, Tatjana Petrinic, Antoine Herpain, Anthony S. McLean, Fernando Clau-Terré, Martin Balik, Daniel De Backer, Stephen Huang, Sam Orde, Antoine Vieillard-Baron, Philippe Vignon, Armand Mekontso-Dessap, Paul H. Mayo, Iwan C. C. van der Horst, Filippo Sanfilippo, MUMC+: MA Intensive Care (3), Intensive Care, MUMC+: MA Medische Staf IC (9), RS: Carim - V04 Surgical intervention, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), European Society of Intensive Care Medicine, ESICM, and PRICES was endorsed and supported by the European Society of Intensive Care Medicine.
- Subjects
medicine.medical_specialty ,Consensus ,systolic function ,Critical Care ,left ventricle ,[SDV]Life Sciences [q-bio] ,VENTRICULAR DIASTOLIC FUNCTION ,Fluid management ,right ventricle ,Critical Care and Intensive Care Medicine ,RECOMMENDATIONS ,03 medical and health sciences ,0302 clinical medicine ,Diastole ,Anesthesiology ,medicine ,fluid responsiveness ,Humans ,Medical physics ,Critical index ,health care economics and organizations ,Statement (computer science) ,Ventricular function ,business.industry ,MORTALITY ,diastolic function ,Expert consensus ,030208 emergency & critical care medicine ,Heart ,DYSFUNCTION ,Checklist ,3. Good health ,SEPTIC PATIENTS ,030228 respiratory system ,Echocardiography ,Research studies ,business - Abstract
Purpose: Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies.Methods: The PRICE panel identified lists of clinical and echocardiographic parameters (the "items") deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts' opinion into account.Results: A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed.Conclusion: The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.
- Published
- 2020
13. COVID-US: A simplified approach to cardiopulmonary ultrasound in suspected and confirmed COVID-19 patients in surge crisis
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Marek Nalos, Sam Orde, James Anstey, Konstantin Yastrebov, Vinodh B Nanjayya, Yang Yang, Cartan Costello, and Nicholas Patrick George Ryan
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,ultrasound ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Ultrasound ,Disease progression ,Cardiorespiratory fitness ,030218 nuclear medicine & medical imaging ,Rapid assessment ,03 medical and health sciences ,0302 clinical medicine ,Radiology Nuclear Medicine and imaging ,Intensive care ,Emergency medicine ,Pandemic ,Technical Note ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,COVID 19 ,intensive care - Abstract
The severe acute respiratory syndrome coronavirus 2 (COVID‐19) pandemic has placed an unprecedented challenge on healthcare systems across the globe. Rapid assessment of the cardiorespiratory function to monitor disease progression and guide treatment is essential. Therefore, we have designed the COVID‐US: a simplified cardiopulmonary ultrasound approach to use in suspected and confirmed COVID‐19 patients, to aid front‐line health workers in their decision‐making in a surge crisis.
- Published
- 2020
14. Contrast echocardiography
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Sam Orde
- Abstract
Echocardiography in the intensive care unit (ICU) is notorious for being difficult to perform, leading to frustratingly non-diagnostic studies with a lack of confidence in findings. The use of ultrasound contrast to enhance these images has the potential to salvage inconclusive studies and change management in critically ill patients. Ultrasound contrast, once ‘activated’, produces tiny microspheres containing an inert gas with a stabilizing shell with a diameter of approximately 1–5 μm. Injected intravenously they pass through the pulmonary microcirculation into the systemic circulation. They last approximately 3–5 minutes and remain entirely in the vascular space. The gas is released unchanged by the lungs and the stabilizing shell is typically metabolized by the reticuloendothelial system or by fatty acid metabolism. These agents are essentially safe in the critically ill. Minor side effects occur in 1–2% and are alleviated by ceasing administration. There is a 1 in 10 000 chance of an anaphylaxis-type reaction and hence cardiopulmonary monitoring for at least 30 minutes after administration is recommended, along with suitable resuscitation measures to deal with this unlikely occurrence. Contrast-enhanced echocardiography can help to accurately detect the endocardial border, ventricular dysfunction, regional wall motion abnormalities, left ventricle thrombi, abnormal masses, and enhance Doppler signals among other potential benefits. In addition, the use of contrast can prevent further investigations and transfer which may be detrimental to the critically ill patient.
- Published
- 2020
15. Strain imaging in right ventricle assessment
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Sam Orde
- Subjects
medicine.anatomical_structure ,business.industry ,Ventricle ,Strain imaging ,Medicine ,Anatomy ,business - Abstract
The right ventricle is now recognized as being integral to cardiac mechanics and analysis of its function is an essential part of any echocardiogram performed in the critically ill patient. However, it has a complex triangular conical shape and is located retrosternally making it difficult to image. Unlike the left ventricle (LV) with its myocardial fibres in many different directions, the right ventricle (RV) has a predominance of longitudinal fibres with most of its movement being in a basal to apex direction. This makes it sensitive to analysis with speckle tracking echocardiography analysis of longitudinal strain: commonly reported as right ventricle free wall strain. Strain is a measure of relative myocardial deformation analysed through tracking of the speckles that make up the myocardium on the two-dimensional B-mode image. It is a postprocessing imaging tool and experience in echocardiography is required before tackling this form of assessment. Strain is sensitive, reproducible, angle independent, not prone to translational error like other conventional echocardiography tools and most importantly can recognize cardiac dysfunction and mechanics that cannot be described by other non-invasive imaging techniques. No echocardiography parameter used to assess right ventricle function is perfect, including right ventricle strain assessment. However its advantages are witnessed by the fact that it has entered clinical practice (exclusively to cardiology departments at this stage) in many larger centres around the world.
- Published
- 2020
16. Valvulopathy Quantification
- Author
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Sam Orde
- Published
- 2020
17. Myocardial Infarction and Complications
- Author
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Sam Orde
- Subjects
medicine.medical_specialty ,business.industry ,Ischemia ,medicine.disease ,Ventricular Septal Rupture ,medicine.anatomical_structure ,Internal medicine ,Heart failure ,Mitral valve ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Wall motion ,Thrombus ,Multiple view ,business - Abstract
Echo can be useful in verifying complications from myocardial infarction, including heart failure, regional wall motion abnormalities, mitral valve abnormalities, thrombus, ischaemic ventricular septal rupture, etc. Echo does not confirm the presence of myocardial ischaemia. Regional wall motion abnormality assessment is one of the harder evaluations; ensure to use multiple views. Some complications from myocardial infarction are common (e.g., heart failure); others are less so (e.g., ischaemic ventricular septal rupture).
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- 2020
18. Transoesophageal Echo Views and Measurements
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Sam Orde
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medicine.medical_specialty ,business.industry ,Haemodynamic monitoring ,fungi ,Echo (computing) ,food and beverages ,Intracardiac injection ,symbols.namesake ,Internal medicine ,cardiovascular system ,Cardiology ,symbols ,Medicine ,cardiovascular diseases ,business ,Doppler effect - Abstract
Tranoesphageal echo can provide information when transthoracic imaging is of insufficient quality. It can be used as both a diagnostic tool and haemodynamic monitoring and characterising causes of shock. It can analyse biventricular and valvular function, pulmonary and left ventricular haemodynamics, as well as intracardiac shunts and aortic pathology. There are relative and absolute contraindications to its use. Doppler angles are often suboptimal. Most can grasp the technique after observing 25 and performing 25–50 studies with suitable supervision.
- Published
- 2020
19. Myocardial Tissue Characterization with Echocardiography in Critical Care
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Sam Orde and Konstantin Yastrebov
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medicine.medical_specialty ,Myocardial tissue ,Critically ill ,Computer science ,Intensive care ,Critical illness ,Visual assessment ,Quantitative assessment ,medicine ,Myocardial motion ,Medical physics - Abstract
Characterization of tissue in echocardiography starts with visual assessment of the regular greyscale 2D imaging. However, this does not allow to examine intricate structural and functional components of the myocardium. Myocardial motion and deformation carry the wealth of information, offering new understanding of the physiology and pathophysiology of critical illness and our interventions. It brings new level of diagnostic opportunities. Qualitative and quantitative assessment of cardiac tissue became possible with the developments in tissue Doppler applications and speckle tracking technologies. Both techniques are now incorporated in a routine advanced cardiological echocardiographic assessment but made little inroads into routine intensive care practice. In particular, there is only very limited research and clinical use of strain and strain rate analysis in critically ill. The opportunities are endless and there is real prospect of clinically meaningful utilization with potential positive impact on outcomes. This chapter is designed to help practitioners with advanced echocardiographic skills to master tissue Doppler and speckle tracking techniques for the use in critical care environment. It describes the necessary technical principles, practical tips, indications and limitations for ICU. This highly illustrated chapter will help to understand complex presentations of tissue analysis in multiple clinical scenarios.
- Published
- 2019
20. Paradoxical septal motion: A diagnostic approach and clinical relevance
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Michel Slama, David J. Clancy, Anthony S. McLean, and Sam Orde
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,Cardiac pacing ,business.industry ,Left bundle branch block ,Review Article ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,Motion (physics) ,Cardiac surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,030228 respiratory system ,Form and function ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,cardiovascular diseases ,business - Abstract
Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.
- Published
- 2018
21. Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort
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Anthony S. McLean, M G Pittard, Stephen Huang, and Sam Orde
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Severity of illness ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Septic shock ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,Water-Electrolyte Balance ,medicine.disease ,Shock, Septic ,Confidence interval ,Anesthesiology and Pain Medicine ,Cohort ,Emergency medicine ,Female ,Observational study ,business - Abstract
In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.
- Published
- 2017
22. Intermediate level training: A paradigm requiring reflective competence
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Andrew S Lane and Sam Orde
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03 medical and health sciences ,Medical education ,0302 clinical medicine ,business.industry ,Correspondence ,Medicine ,030208 emergency & critical care medicine ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,Intermediate level ,business ,Competence (human resources) - Published
- 2017
23. Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures
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Sam Orde, Michel Slama, Konstantin Yastrebov, Anthony Mclean, Stephen Huang, and on behalf of the College of Intensive Care Medicine of Australia and New Zealand [CICM] Ultrasound Special Interest Group [USIG]
- Subjects
Adult ,Male ,Ordinal data ,medicine.medical_specialty ,Critical Care ,Heart Ventricles ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Free wall ,Diagnostic Self Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Intensive care ,Internal medicine ,medicine ,Humans ,Critically ill ,Categorical scale ,Speckle tracking ,Aged ,Mechanical ventilation ,Chi-Square Distribution ,business.industry ,Research ,Subjective assessment ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Reproducibility of Results ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Middle Aged ,Intensive Care Units ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,ICU ,Rv function ,Ventricular Function, Right ,Cardiology ,Right ventricle ,Female ,Clinical Competence ,business - Abstract
Background Right ventricle (RV) size and function assessment by echocardiography (echo) is a standard tool in the ICU. Frequently subjective assessment is performed, and guidelines suggest its utility in adequately trained clinicians. We aimed to compare subjective (visual) assessment of RV size and function by ICU physicians, with advanced qualifications in echocardiography, vs objective measurements. Methods ICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO2
- Published
- 2019
24. Calibrated cardiac output monitoring versus standard care for fluid management in the shocked ICU patient: a pilot randomised controlled trial
- Author
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Timothy Scully, Anthony S. McLean, Robert Grealy, and Sam Orde
- Subjects
Cardiac output ,medicine.medical_treatment ,Fluid responsiveness ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Sepsis and fluid administration ,Standard care ,Randomized controlled trial ,law ,Medicine ,Minimally invasive ,business.industry ,Research ,Clinical study design ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Shock ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,030228 respiratory system ,Anesthesia ,Shock (circulatory) ,Cardiac output monitoring ,Cardiac monitoring ,medicine.symptom ,business - Abstract
Background Despite the evidence for calibrated cardiac monitored devices to determine fluid responsiveness, there is minimal evidence that the use of cardiac output monitor devices leads to an overall change in IV fluid use. We sought to investigate the feasibility of performing a randomised controlled study using calibrated cardiac output monitoring devices in shocked ICU patients and whether the use of these devices led to a difference in total volume of IV fluid administered. Methods We performed a single-centre non-blinded randomised controlled study which included patients who met the clinical criteria for shock on admission to ICU. Patients were divided into two groups (cardiac output monitors or standard) by block randomisation. Patients allocated to the cardiac output monitor all received EV1000 with Volume View sets. Daily intravenous fluid administration and cumulative fluid balance was recorded for 3 days. The primary outcome assessed was the difference in daily intravenous fluid administration and cumulative fluid balance at 72 h between the two groups. We also assessed how often the clinicians used the cardiac monitor to guide fluid therapy and the different reasoning for initiating further intravenous fluids. Results Eighty patients were randomised and 37 received calibrated cardiac output monitors. We found no adverse outcomes in the use of calibrated cardiac output monitoring devices and that was feasible to perform a randomised controlled trial. There was no significant difference between the standard care group vs the cardiac monitoring group for cumulative fluid balance (2503 ± 3764 ml vs 2458 ± 3560 ml, p = 0.96). There was no significant difference between the groups for daily intravenous fluid administration on days 1, 2 or 3. In the cardiac monitored group, only 43% of the time was the EV1000 output incorporated into the decision to give further intravenous fluids. Conclusion It is feasible to perform a randomised controlled trial using calibrated cardiac output monitoring devices. In addition, there was no trend to suggest that the use of a cardiac monitors leads to lower IV fluid use in the shocked patient. Further trials will require study designs to optimise the use of a cardiac output monitor to determine the utility of these devices in the shocked patient. Trial registration ANZCTR, ACTRN12618001373268. Registered 15 August 2018—retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s40560-018-0356-y) contains supplementary material, which is available to authorized users.
- Published
- 2019
25. The Challenging Diagnosis of Septic Cardiomyopathy
- Author
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Marinella Astuto, Sabino Scolletta, Francesco Oliveri, Sam Orde, and Filippo Sanfilippo
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,MEDLINE ,Heart ,Critical Care and Intensive Care Medicine ,Text mining ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Cardiomyopathies ,Septic cardiomyopathy - Published
- 2019
26. Subcostal TAPSE: a retrospective analysis of a novel right ventricle function assessment method from the subcostal position in patients with sepsis
- Author
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Sam Orde, Anthony S. McLean, Andrew J. Inglis, Rachel Braham, Daniel Campbell, and Alison B. Main
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Poor prognosis ,Adverse outcomes ,lcsh:R895-920 ,Apical four chamber ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Retrospective analysis ,Radiology, Nuclear Medicine and imaging ,In patient ,Subcostal ,Radiological and Ultrasound Technology ,business.industry ,Critically ill ,030208 emergency & critical care medicine ,medicine.disease ,Tricuspid annular plane systolic excursion ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Assessment methods ,Cardiology ,Right ventricle ,Original Article ,business - Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is frequently used as an objective measure of right-ventricular dysfunction. Abnormal TAPSE values are associated with poor prognosis in a number of disease states; however, the measure is not always easy to obtain in the critically ill. The purpose of this study is to assess the feasibility and accuracy of using a subcostal view and TAPSE measurement as a measure of right-ventricular dysfunction. A secondary aim was to perform a pilot study to assess whether right-ventricular dysfunction was associated with adverse outcomes including mortality. Results Subcostal TAPSE corresponds well with TAPSE obtained from the apical window at low and moderate TAPSE values (mean difference 1.2 mm (CI 0.04–2.36; 100% data pairs
- Published
- 2018
27. Reassessment of the Accuracy of Cardiac Doppler Pulmonary Artery Pressure Measurements in Ventilated ICU Patients: A Simultaneous Doppler-Catheterization Study
- Author
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Loay Kontar, Julien Maizel, Stephen Huang, Pablo Mercado, Christophe Beyls, Anthony S. McLean, Christophe Tribouilloy, Michel Slama, and Sam Orde
- Subjects
Male ,medicine.medical_specialty ,Central Venous Pressure ,Systole ,medicine.medical_treatment ,Hypertension, Pulmonary ,Diastole ,Blood Pressure ,Regurgitation (circulation) ,Doppler echocardiography ,Pulmonary Artery ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,Prospective Studies ,Mechanical ventilation ,medicine.diagnostic_test ,business.industry ,Central venous pressure ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Respiration, Artificial ,Echocardiography, Doppler ,Tricuspid Valve Insufficiency ,Intensive Care Units ,030228 respiratory system ,Pulmonary artery ,Cardiology ,Female ,Isovolumic relaxation time ,business ,Blood Flow Velocity - Abstract
Objectives Doppler echocardiography is a well-recognized technique for the noninvasive evaluation of pulmonary artery pressure; however, little information is available concerning patients receiving mechanical ventilation. Furthermore, recent studies have debatable results regarding the relevance of this technique to assess pulmonary artery pressure. The aim of our study was to reassess the accuracy of Doppler echocardiography to evaluate pulmonary artery pressure and to predict pulmonary hypertension. Design Prospective observational study. Setting Amiens ICU, France. Patients ICU patients receiving mechanical ventilation. Interventions In 40 patients, we simultaneously recorded Doppler echocardiography variables (including tricuspid regurgitation and pulmonary regurgitation) and invasive central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, and mean pulmonary artery pressure. Measurements and main results Systolic pulmonary artery pressure assessed from the tricuspid regurgitation derived maximal pressure gradient added to the central venous pressure demonstrated the best correlation with the invasive systolic pulmonary artery pressure (r = 0.87) with a small bias (-3 mm Hg) and a precision of 9 mm Hg. A Doppler echocardiography systolic pulmonary artery pressure greater than 39 mm Hg predicted pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg) with 100% sensitivity and specificity. Tricuspid regurgitation maximal velocity greater than 2.82 m/s as well as tricuspid regurgitation pressure gradient greater than 32 mm Hg predicted the presence of pulmonary hypertension. Pulmonary regurgitation was recorded in 10 patients (25%). No correlation was found between pulmonary regurgitation velocities and either mean pulmonary artery pressure or diastolic pulmonary artery pressure. Pulmonary acceleration time less than 57 ms and isovolumic relaxation time less than 40 ms respectively predicted pulmonary hypertension 100% of the time and had a 100% negative predictive value. Conclusions Tricuspid regurgitation maximal velocity pressure gradient added to invasive central venous pressure accurately estimates systolic pulmonary artery pressure and mean pulmonary artery pressure in ICU patients receiving mechanical ventilation and may predict pulmonary hypertension.
- Published
- 2018
28. Management of straddling thrombus through patent foramen ovale complicating pulmonary embolism
- Author
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Vijeth Bhat, Sam Orde, and Stuart lane
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Left atrium ,Foramen Ovale, Patent ,Case Report ,030105 genetics & heredity ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,law ,medicine ,Humans ,Thrombus ,medicine.diagnostic_test ,business.industry ,Thrombosis ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Intensive care unit ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Patent foramen ovale ,Pulmonary Embolism ,business ,Echocardiography, Transesophageal ,030217 neurology & neurosurgery ,Embolism, Paradoxical - Abstract
A 60-year-old man was admitted to intensive care unit with the diagnosis of pulmonary embolism. Bedside transthoracic echocardiography revealed the extension of the thrombus into left atrium and ventricle through patent foramen ovale (PFO). A straddling thrombus also described as impending paradoxical embolism is a rare condition when thrombus embolised to the heart gets caught in PFO. Morbidity is extremely high in case of systemic embolisation. Due to rarity, the treatment options are mainly individualised and no guidelines exist. There are few treatment strategies described in literature from surgical to interventional radiology to conservative approach. Treatment strategy should take individual parameters such as patient’s age, haemodynamic stability, bleeding risk and comorbidities into consideration. Our patient successfully underwent emergency surgical thrombectomy.
- Published
- 2021
29. Feasibility of biventricular 3D transthoracic echocardiography in the critically ill and comparison with conventional parameters
- Author
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Nicola Stanley, Stephen Huang, Michel Slama, Anthony S. McLean, and Sam Orde
- Subjects
Male ,Critical Illness ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Biplane ,law.invention ,Cohort Studies ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,law ,medicine ,Humans ,Critically ill ,Aged ,Monitoring, Physiologic ,medicine.diagnostic_test ,business.industry ,Research ,Australia ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Reproducibility of Results ,030208 emergency & critical care medicine ,Magnetic resonance imaging ,Atrial fibrillation ,lcsh:RC86-88.9 ,Stroke volume ,Middle Aged ,Weights and Measures ,medicine.disease ,Intensive care unit ,Echocardiography ,ICU ,Ventilation (architecture) ,symbols ,Female ,Nuclear medicine ,business ,Doppler effect ,Perfusion ,3D - Abstract
Background Transthoracic 3D cardiac analysis is enticing in its potential simplicity and wealth of data available. It has been suggested to be accurate vs magnetic resonance imaging in relatively stable patients, but feasibility and agreement with conventional echocardiographic assessment of stroke volume (SV) have not been thoroughly assessed in critically ill patients, who are traditionally harder to image. The objectives of this study were to compare 3D transthoracic volumetric analysis vs Doppler assessment of SV (which is suggested to be accurate in the critically ill) and Simpson’s biplane assessment in a cohort typical of the intensive care unit (ICU), where accurate assessment is important: mechanically ventilated patients with a significant ventilation/perfusion (V/Q) mismatch. We hypothesised that it would be feasible but might lack agreement. Methods Patients were imaged within 24 hours of admission. Inclusion criteria were adult patients, V/Q mismatch present (defined as a ratio of arterial oxygen partial pressure to fractional inspired oxygen
- Published
- 2018
30. Moderate and Severe Acute Respiratory Distress Syndrome: Hemodynamic and Cardiac Effects of an Open Lung Strategy With Recruitment Maneuver Analyzed Using Echocardiography
- Author
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Michel Slama, Pablo Mercado, Anthony S. McLean, Marek Nalos, Sam Orde, Loay Kontar, Stephen Huang, and Julien Maizel
- Subjects
Male ,medicine.medical_specialty ,Hemodynamics ,Acute respiratory distress ,Critical Care and Intensive Care Medicine ,Cardiac dysfunction ,Positive-Pressure Respiration ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Recruitment maneuver ,Internal medicine ,Outcome Assessment, Health Care ,Tidal Volume ,Medicine ,Humans ,Lung ventilation ,Aged ,Respiratory Distress Syndrome ,Lung ,Airway pressures ,business.industry ,030208 emergency & critical care medicine ,Limiting ,respiratory system ,Middle Aged ,medicine.anatomical_structure ,Cardiology ,Respiratory Mechanics ,Female ,France ,business ,Echocardiography, Transesophageal - Abstract
Open lung ventilation with a recruitment maneuver could be beneficial for acute respiratory distress syndrome patients. However, the increased airway pressures resulting from the recruitment maneuver may induce cardiac dysfunction, limiting the benefit of this maneuver. We analyzed the effect of a recruitment maneuver and decremental positive end-expiratory pressure titration on cardiac function.Medical ICU Amiens, France.Twenty patients with moderate to severe acute respiratory distress syndrome INTERVENTIONS:: Patients underwent a stepwise recruitment maneuver with respiratory evaluation and echocardiography assessment of cardiac function including longitudinal strain at baseline, peak positive end-expiratory pressure of recruitment maneuver (positive end-expiratory pressure 40 cm H2O), and at "optimal" positive end-expiratory pressure. The patients were divided into two groups based on change on the PaO2/FIO2 ratio (nonresponders50%; responders ≥ 50%).At peak positive end-expiratory pressure during the recruitment maneuver, the arterial pressure, cardiac output, left ventricular size decreased and right ventricular size increased. The left ventricular ejection fraction decreased from 60% ± 13% to 48% ± 18% (p = 0.05). Both left and right ventricular global longitudinal strain were impaired (-15.8% ± 4.5% to -11% ± 4.7% and -19% ± 5% to -14% ± 6% [p = 0.05] respectively). Fifty percent of patients were nonresponders and demonstrated a lower hemodynamic tolerance to the recruitment maneuver than responders. Optimal positive end-expiratory pressure was 14 ± 5 cm H2O (vs 11 ± 4 cm H2O at baseline), and PaO2/FIO2 ratio increased from 111 ± 25 to 197 ± 89 mm Hg (p0.0001). All hemodynamic variables returned to their baseline value after the recruitment maneuver despite a higher positive end-expiratory pressure.An open lung strategy with a stepwise recruitment maneuver permitted a higher positive end-expiratory pressure and improved oxygenation without any cardiac impairment. The recruitment maneuver was associated with mild and transient, cardiac dysfunction, with nonresponders demonstrating poorer tolerance.
- Published
- 2018
31. The stop-flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography
- Author
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Irina Volobueva, Evgeniy Polovnikov, Anders Aneman, Andrew Hilton, Svetlana Sidelnikova, Michel Slama, Sam Orde, Vladimir Kokhno, Dmitriy Lukiyanov, Vsevolod Luchansky, and Konstantin Yastrebov
- Subjects
Adult ,Male ,medicine.medical_specialty ,Diastole ,Hemodynamics ,Vena Cava, Inferior ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Preoperative Care ,Intravascular volume status ,medicine ,Humans ,Arterial Pressure ,030212 general & internal medicine ,Prospective Studies ,Body surface area ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,Anesthesiology and Pain Medicine ,Blood pressure ,medicine.vein ,Mean circulatory filling pressure ,Echocardiography ,Circulatory system ,Radial Artery ,Cardiology ,Fluid Therapy ,Female ,business - Abstract
BACKGROUND The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling. METHODS Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia. The no-flow equilibrium pressure in the arm following rapid circulatory occlusion (Parm ) was measured via a radial arterial catheter. Transthoracic echocardiography was used to measure left ventricular end diastolic area and volume as well as the diameter of the inferior vena cava. The Parm and echocardiographic variables were measured before and after administration of 500 mL 0.9% NaCl over 10 minutes. Changes were analysed by paired t test, Pearson's correlation and multiple linear regression. RESULTS Parm increased overall from 22 ± 5 mm Hg to 25 ± 6 mm Hg (mean difference 3.0 ± 4.5 mm Hg, P = 0.002) following the fluid bolus with corresponding increases in arterial pressure and echocardiographic variables. Variability in the direction of the Parm response reflected concomitant changes in vascular compliance. Only weak correlations were observed between changes in Parm and inferior vena cava diameter indexed to body surface area (R2 = 0.29, P = 0.01). CONCLUSION Preoperative measurements of Parm increased following acute expansion of the intravascular volume. Echocardiography demonstrated poor correlation with Parm .
- Published
- 2018
32. The comparative effects of 3% saline and 0.5M sodium lactate on cardiac function:a randomised, crossover study in volunteers
- Author
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Marek, Nalos, Euguenia, Kholodniak, Louise, Smith, Sam, Orde, Iris, Ting, Michel, Slama, Ian, Seppelt, Anthony S, McLean, and Stephen, Huang
- Subjects
Saline Solution, Hypertonic ,Sodium Lactate ,Volunteers ,Cross-Over Studies ,Double-Blind Method ,Humans ,Heart ,Sodium Chloride - Abstract
To investigate the metabolic and cardiac effects of intravenous administration of two hypertonic solutions - 3% saline (SAL) and 0.5M sodium lactate (LAC).A randomised, doubleblind, crossover study in ten human volunteers. Intravenous bolus of either SAL or LAC at 3 mL/kg over 20 min followed by a 2 mL/kg infusion over 60 min.Acid base parameters and echocardiographic indices of cardiac function, cardiac output (CO), left ventricular ejection fraction (LVEF) and mitral annular peak systolic velocity (Sm) before and after infusion of SAL or LAC.Despite haemodilution, we observed an increase in sodium (139 ± 2 mmol/L to 142 ± 2 mmol/L in both groups) and respective anions, chloride (106 ± 2 mmol/L to 112 ± 3 mmol/L) and lactate (1.01 ± 0.28 mmol/L to 2.38 ± 0.38 mmol/L) with SAL and LAC, respectively. The pH (7.37 ± 0.03 to 7.45 ± 0.03; P0.01) and simplified strong ion difference (SID) (36.3 ± 4.6 mmol/L to 39.2 ± 3.6 mmol/L; P0.01) increased during the LAC infusion. The pH was unchanged, but SID decreased during SAL infusion (36.3 ± 2.5 mmol/L to 33.9 ± 3.1 mmol/L; P = 0.01). Both solutions led to an increase in preload and cardiac function, CO (4.36 ± 0.79 L/min to 4.98 ± 1.37 L/ min v 4.62 ± 1.30 L/min to 5.13 ± 1.44 L/min), LVEF (61 ± 6% to 63 ± 8% v 64 ± 6% to 68 ± 7%). The averaged Sm improved in the LAC group as compared with the SAL group (0.088 ± 0.008 to 0.096 ± 0.016 v 0.086 ± 0.012 to 0.082 ± 0.012; P = 0.032).The administration of SAL or LAC has opposing effects on acid base variables such as SID. Hypertonic fluid infusion lead to increased cardiac preload and performance with Sm, suggesting better left ventricular systolic function during LAC as compared with SAL. Lactated hypertonic solutions should be evaluated as resuscitation fluids.
- Published
- 2018
33. Diagnostic workup, etiologies and management of acute right ventricle failure:A state-of-the-art paper
- Author
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Ginelle A. Schmidt, Antoine Vieillard-Baron, Sam Orde, Tim Lahm, Harm Jan Bogaard, Francois Haddad, Todd M. Bull, Michael R. Pinsky, Sheldon Magder, Robert Naeije, and Nick Fletcher
- Subjects
Adult ,Male ,Inotrope ,Cardiac output ,medicine.medical_specialty ,Critical Illness ,Heart Ventricles ,Ventricular Dysfunction, Right ,Hemodynamics ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Internal medicine ,medicine ,Humans ,Aged ,Aged, 80 and over ,business.industry ,030208 emergency & critical care medicine ,Stroke volume ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Preload ,Shock (circulatory) ,Cardiology ,Female ,medicine.symptom ,business - Abstract
INTRODUCTION: This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors.RESULTS: The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation. While no universal definition of RVF is accepted, we propose that RVF may be defined as a state in which the right ventricle is unable to meet the demands for blood flow without excessive use of the Frank-Starling mechanism (i.e. increase in stroke volume associated with increased preload). Both echocardiography and hemodynamic monitoring play a central role in the evaluation of RVF in the ICU. Management of RVF includes treatment of the causes, respiratory optimization and hemodynamic support. The administration of fluids is potentially deleterious and unlikely to lead to improvement in cardiac output in the majority of cases. Vasopressors are needed in the setting of shock to restore the systemic pressure and avoid RV ischemia; inotropic drug or inodilator therapies may also be needed. In the most severe cases, recent mechanical circulatory support devices are proposed to unload the RV and improve organ perfusion CONCLUSION: RV function evaluation is key in the critically-ill patients for hemodynamic management, as fluid optimization, vasopressor strategy and respiratory support. RV failure may be diagnosed by the association of different devices and parameters, while echocardiography is crucial.
- Published
- 2018
34. Bedside lung ultrasound in the care of the critically ill
- Author
-
Máté, Rudas, Sam, Orde, and Marek, Nalos
- Subjects
Lung Diseases ,Chest Pain ,Critical Care ,Critical Illness ,Point-of-Care Systems ,Resuscitation ,Shock ,Unnecessary Procedures ,Heart Arrest ,Humans ,Hypotension ,Lung ,Ventilator Weaning ,Algorithms ,Respiratory Sounds ,Ultrasonography - Abstract
To describe the technique and review the utility of bedside lung ultrasound in acute care.Lung ultrasound is a useful point-of-care investigation in acute care, especially in patients with dyspnoea or haemodynamic instability. Although normal lung parenchyma is not accessible to ultrasound, distinctive artefacts arising from parietal and visceral pleura indirectly imply the presence of normal lung. As aeration of lung tissue reduces with disease process, visual assessment of several pathologic entities by ultrasound becomes possible. Ultrasound can be used for qualitative and quantitative assessment as well as to guide intervention. Compared with supine anteroposterior chest x-rays, lung ultrasound is faster and superior at ruling out pneumothorax and diagnosing lung consolidation, pleural effusions or pulmonary oedema. It is a logical and highly valuable extension of echocardiography and can be incorporated into diagnostic algorithms for assessment of dyspnoea, hypotension, chest pain or trauma. It provides rapid information about potentially reversible pathology in cardiac arrest scenarios. Other advantages include bedside availability, repeatability, provision of dynamic diagnostic information, ease of use and the absence of radiation exposure.
- Published
- 2017
35. Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock
- Author
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Anthony S. McLean, Michel Slama, Sam Orde, David J. Clancy, Stephen Huang, and Timothy Scully
- Subjects
medicine.medical_specialty ,Diastolic function ,Diastole ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Anesthesiology ,medicine ,In patient ,business.industry ,Septic shock ,Research ,Incidence (epidemiology) ,Systolic function ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Guideline ,medicine.disease ,Cohort ,Cardiology ,business - Abstract
Background Left ventricular diastolic dysfunction is suggested to be associated with higher mortality in severe sepsis and septic shock, yet the methods of diagnosis described in the literature are often inconsistent. The recently published 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines offer the opportunity to apply a simple pragmatic diagnostic algorithm for the detection of diastolic dysfunction; however, it has not been tested in this cohort. Aims We sought to assess the applicability in septic patients of recently published 2016 ASE/EACVI guidelines on diastolic dysfunction compared with the 2009 ASE guidelines. Our hypothesis was that there would be poor agreement in classifying patients. Methods Prospective observational study includes patients identified as having severe sepsis and septic shock. Patients underwent transthoracic echocardiography on day 1 and day 3 of their ICU admission. Patients with normal and abnormal (ejection fraction
- Published
- 2017
36. Pearls and pitfalls in comprehensive critical care echocardiography
- Author
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Michel Slama, Anthony S. McLean, Sam Orde, Andrew Hilton, and Konstantin Yastrebov
- Subjects
medicine.medical_specialty ,Review ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Humans ,Medicine ,Intensive care medicine ,business.industry ,Critically ill ,Interpretation (philosophy) ,Doppler ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Stroke Volume ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,Critical care ,Echocardiography ,Heart Function Tests ,Advanced ,Medical emergency ,business - Abstract
Critical care echocardiography is developing rapidly with an increasing number of specialists now performing comprehensive studies using Doppler and other advanced techniques. However, this imaging can be challenging, interpretation is far from simple in the complex critically ill patient and mistakes can be easy to make. We aim to address clinically relevant areas where potential errors may occur and suggest methods to hopefully improve accuracy of imaging and interpretation.
- Published
- 2017
37. Basic critical care echocardiography: How many studies equate to competence? A pilot study using high fidelity echocardiography simulation
- Author
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Anthony S. McLean, Idunn S Morris, Sam Orde, and Emma Bowcock
- Subjects
03 medical and health sciences ,Medical education ,0302 clinical medicine ,High fidelity ,business.industry ,Medicine ,030208 emergency & critical care medicine ,Original Articles ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,business ,Competence (human resources) - Abstract
Background Assessment of competence in basic critical care echocardiography is complex. Competence relies on not only imaging accuracy but also interpretation and appropriate management decisions. The experience to achieve these skills, real-time, is likely more than required for imaging accuracy alone. We aimed to assess the feasibility of using simulation to assess number of studies required to attain competence in basic critical care echocardiography. Methods This is a prospective pilot study recruiting trainees at various degrees of experience in basic critical care echocardiography using experts as reference standard. We used high fidelity simulation to assess speed and accuracy using total time taken, total position difference and total angle difference across the basic acoustic windows. Interpretation and clinical application skills were assessed using a clinical scenario. ‘Cut-off’ values for number of studies required for competence were estimated. Results Twenty-seven trainees and eight experts were included. The subcostal view was achieved quickest by trainees (median 23 s, IQR 19–37). Eighty-seven percent of trainees did not achieve accuracy across all views; 81% achieved accuracy with the parasternal long axis and the least accurate was the parasternal short axis (44% of trainees). Fewer studies were required to be considered competent with imaging acquisition compared with competence in correct interpretation and integration (15 vs. 40 vs. 50, respectively). Discussion The use of echocardiography simulation to determine competence in basic critical care echocardiography is feasible. Competence in image acquisition appears to be achieved with less experience than correct interpretation and correct management decisions. Further studies are required.
- Published
- 2017
38. Prevalence of ultrasound use and attitudes towards training among fellows of the College of Intensive Care Medicine of Australia and New Zealand
- Author
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Andrew Hilton, Konstantin Yastrebov, and Sam Orde
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Family medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Letter to the Editor ,Training (civil) - Published
- 2019
39. Speckle tracking echocardiography in the critically ill: enticing research with minimal clinical practicality or the answer to non-invasive cardiac assessment?
- Author
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Sam Orde, Stephen Huang, and Anthony S. McLean
- Subjects
medicine.medical_specialty ,Pathology ,business.industry ,Critically ill ,Critical Illness ,Non invasive ,Cardiomyopathy ,030208 emergency & critical care medicine ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,medicine.disease ,Standard measure ,Myocardial function ,Cardiac dysfunction ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Echocardiography ,Critical illness ,Heart Function Tests ,medicine ,Humans ,Intensive care medicine ,business - Abstract
Echocardiography is developing rapidly. Speckle tracking echocardiography is the latest semi-automatic tool that has potential to quantitatively describe cardiac dysfunction that may be unrecognised by conventional echocardiography. It is a non-Doppler, angle-independent, feasible and reproducible method to evaluate myocardial function in both non–critically ill and critically ill populations. Increasingly it has become a standard measure of both left and right ventricle function in specific patient groups, e.g. chemotherapy-induced cardiomyopathy or pulmonary hypertension. To date there are few studies in the critically ill, predominantly in sepsis, yet all describe dysfunction beyond standard measures. Other areas of interest include heart–lung interactions, right ventricle function and twist and torsion of the heart. A word of caution is required, however, in that speckle tracking echocardiography is far from perfect and is more challenging, particularly in the critically ill, than implied by many published studies. It takes time to learn and perform and most values are not validated, particularly in the critically ill. We should be cautious in accepting that the latest software used in cardiology cohorts will automatically be the answer in the critically ill. Even with these limitations the technology is enticing and results fascinating. We are uncovering previously undescribed dysfunction and although it currently is essentially a research-based activity, there is great promise as a clinical tool as echocardiography analysis becomes more automated, and potentially speckle tracking echocardiography could help describe cardiac function in critical illness more accurately than is possible with current techniques.
- Published
- 2016
40. Reversal in order of ventricular filling is associated with a positive fluid balance in sepsis
- Author
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Timothy Scully, Sam Orde, David J. Clancy, and Anthony S. McLean
- Subjects
business.industry ,030208 emergency & critical care medicine ,Water-Electrolyte Balance ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,medicine.disease ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Positive fluid balance ,Echocardiography ,Anesthesia ,medicine ,Humans ,Ventricular Function ,Prospective Studies ,Ventricular filling ,business - Published
- 2017
41. Diabetic ketoacidosis due to fulminant type 1 diabetes: A rare subtype of type 1 diabetes leading to unusual sequelae
- Author
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Danijela Dravec, Bernard Champion, Andrew S Lane, and Sam Orde
- Subjects
medicine.medical_specialty ,Type 1 diabetes ,Pediatrics ,Diabetic ketoacidosis ,biology ,business.industry ,Fulminant ,Cardiomyopathy ,Case Reports ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,medicine.disease ,Troponin ,Internal medicine ,medicine ,Genetic predisposition ,biology.protein ,Cardiology ,Pneumomediastinum ,business ,Complication - Abstract
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D), which without treatment leads to death. Fulminant type 1 diabetes (FT1D) is a subtype characterised by a markedly rapid and almost complete destruction of pancreatic β-cells, with acute onset leading to severe metabolic derangement and commonly ICU admission. We present a case of an 18-year-old male presenting with FT1D with two rare complications of pneumomediastinum and stress-induced cardiomyopathy (SIC) with significant myocardial necrosis. We also discuss the aetiology of the pneumomediastinum; the latest thoughts on SIC: moving beyond the simple description of ‘Takotsubo cardiomyopathy’; the role of troponins in critical illness; and genetic predisposition for DKA due to FT1D.
- Published
- 2014
42. Why guess when you can see? Heart function and fluid management in dengue shock
- Author
-
Ian Seppelt and Sam Orde
- Subjects
Male ,medicine.medical_specialty ,Endemic Diseases ,business.industry ,Fluid management ,Critical Care and Intensive Care Medicine ,medicine.disease ,Article ,Dengue fever ,Surgery ,Dengue ,Cardiovascular Diseases ,Shock (circulatory) ,medicine ,Humans ,Female ,medicine.symptom ,Intensive care medicine ,business ,Ultrasonography - Published
- 2012
43. [Untitled]
- Author
-
Rakesh M. Suri, John M. Stulak, Juan N. Pulido, Jae Oh, Garvan C. Kane, and Sam Orde
- Subjects
medicine.medical_specialty ,Ventricular function ,business.industry ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Speckle tracking echocardiography ,Critical Care and Intensive Care Medicine ,business ,Cardiac surgery - Abstract
Introduction: Right ventricular (RV) dysfunction can occur after cardiac surgery. Although the exact mechanism is not well understood, it has been suggested to be associated with pericardial incision as well as other factors related to cardiac surgery. Speckle Tracking Echocardiography was performed
- Published
- 2013
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