Critical care science最新文献

{"title":"Effects of mechanical in-exsufflation in preventing postextubation acute respiratory failure in intensive care acquired weakness patients: a randomized controlled trial.","authors":"Philippe Wibart,&nbsp;Thomas Réginault,&nbsp;Margarita Garcia-Fontan,&nbsp;Bérangère Barbrel,&nbsp;Clement Bader,&nbsp;Antoine Benard,&nbsp;Verônica Franco Parreira,&nbsp;Daniel Gonzalez-Antón,&nbsp;Nam H Bui,&nbsp;Didier Gruson,&nbsp;Gilles Hilbert,&nbsp;Roberto Martinez-Alejos,&nbsp;Frédéric Vargas","doi":"10.5935/2965-2774.20230410-en","DOIUrl":"10.5935/2965-2774.20230410-en","url":null,"abstract":"<p><strong>Objective: </strong>We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients.</p><p><strong>Methods: </strong>This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation. The incidence of acute respiratory failure within 48 hours of extubation was evaluated. Similarly, the reintubation rate, intensive care unit length of stay, mortality at 28 days, and survival probability at 90 days were assessed. The study was stopped after futility results in the interim analysis.</p><p><strong>Results: </strong>We included 122 consecutive patients (n = 61 per group). There was no significant difference in the incidence of acute respiratory failure between treatments (11.5% control group versus 16.4%, intervention group; p = 0.60), the need for reintubation (3.6% versus 10.7%; p = 0.27), mean length of stay (3 versus 4 days; p = 0.33), mortality at Day 28 (9.8% versus 15.0%; p = 0.42), or survival probability at Day 90 (21.3% versus 28.3%; p = 0.41).</p><p><strong>Conclusion: </strong>Mechanical insufflation-exsufflation combined with chest physiotherapy seems to have no impact in preventing postextubation acute respiratory failure in intensive care unit-acquired weakness patients. Similarly, mortality and survival probability were similar in both groups. Nevertheless, given the early termination of the trial, further clinical investigation is strongly recommended.</p><p><strong>Clinical trials register: </strong>NCT01931228.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methemoglobinemia induced by dapsone in a pediatric patient: case report.","authors":"Ana Clara Burgos,&nbsp;Alexandre Neves da Rocha Santos,&nbsp;José Colleti Junior,&nbsp;Eduardo Juan Troster","doi":"10.5935/2965-2774.20230018-en","DOIUrl":"10.5935/2965-2774.20230018-en","url":null,"abstract":"Methemoglobinemia is a rare condition and one of the differential diagnoses of cyanosis in the pediatric age group.(1) Clinical symptoms vary according to the levels of methemoglobin (MetHb) in the blood and may be nonspecific. The most common symptoms are central cyanosis, headache, fatigue, and respiratory depression.(2) Therefore, it is essential to recognize and treat the underlying cause. Methemoglobinemia is a syndrome of varied etiology, which may be congenital or acquired. The main acquired cause is a reaction to chemical agents.(1) One of the drugs most commonly associated with methemoglobinemia is dapsone, a sulfone antibiotic. Its traditional indication is for the treatment of dermatitis herpetiformis, but it is also used in the treatment of leprosy and in the prophylaxis of Pneumocystis jiroveci and toxoplasmosis.(2-5) Its use in oral form for the treatment of acne vulgaris is not well established.(6) This case report presents a patient treated at a pediatric emergency department and her outcome, aiming to discuss the diagnostic difficulties of methemoglobinemia in pediatrics and to draw the pediatric community’s attention to the potential severity of the diagnosis and the indiscriminate use of dapsone. This study was approved by the Ethics Committee of the Hospital Israelita Albert Einstein (HIAE) upon acceptance of the Free Consent Form and CAAE 65121122.6.0000.0071.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond fluid responsiveness: the concept of fluid tolerance and its potential implication in hemodynamic management.","authors":"Rafael Hortêncio Melo,&nbsp;Mauricio Henrique Claro Dos Santos,&nbsp;Fernando José da Silva Ramos","doi":"10.5935/2965-2774.20230012-en","DOIUrl":"10.5935/2965-2774.20230012-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship of postocclusive reactive hyperemia assessed by the plethysmographic perfusion index to lactate clearance: a new piece in the unsolved puzzle of tissue perfusion and oxygenation in septic shock.","authors":"Arnaldo Dubin","doi":"10.5935/2965-2774.2023.Edit-2.v35n2-en","DOIUrl":"10.5935/2965-2774.2023.Edit-2.v35n2-en","url":null,"abstract":"","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2.","authors":"Oscar Orlando Sanabria-Rodríguez,&nbsp;Sergio Leonardo Cardozo-Avendaño,&nbsp;Oscar Mauricio Muñoz-Velandia","doi":"10.5935/2965-2774.20230343-en","DOIUrl":"10.5935/2965-2774.20230343-en","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia.</p><p><strong>Methods: </strong>Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a 'response'. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables.</p><p><strong>Results: </strong>A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 - 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 - 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 - 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 - 2.85) compared with a ground-glass pattern.</p><p><strong>Conclusion: </strong>This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients.","authors":"Timor Omar,&nbsp;Kamil İnci,&nbsp;Yusuf Oflu,&nbsp;Mustafa Dilek,&nbsp;Zeynep Binici Çelik,&nbsp;Soner Kına,&nbsp;Doğan İliş,&nbsp;Halil Murat Bucak","doi":"10.5935/2965-2774.20230378-en","DOIUrl":"10.5935/2965-2774.20230378-en","url":null,"abstract":"<p><strong>Objective: </strong>Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients.</p><p><strong>Methods: </strong>This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission.</p><p><strong>Results: </strong>One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores.</p><p><strong>Conclusion: </strong>Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report.","authors":"Ana Flávia Garcia Silva,&nbsp;Lívia Maria Garcia Melro,&nbsp;Bruno Adler Maccagnan Pinheiro Besen,&nbsp;Pedro Vitale Mendes,&nbsp;Marcelo Park","doi":"10.5935/2965-2774.20230404-en","DOIUrl":"10.5935/2965-2774.20230404-en","url":null,"abstract":"Acute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure that affects people aged 20-40 years old.(1) Patients with AEP present with rapid onset of cough, dyspnea, tachypnea and fever of usually less than 7 days of duration. Hypoxemia is present in all cases, and most patients do not have peripheral blood eosinophilia. In contrast, an increase in eosinophils in bronchoalveolar lavage fluid (BALF) is a marker of the disease, exceeding 20% of the BALF cell count in most patients. Radiographs show mixed reticular and alveolar infiltrates, which then can progress to be densely alveolar as the condition worsens.(2,3) Acute and organizing diffuse alveolar damage is common and is usually responsive to corticosteroids.(1) The major causes of pulmonary eosinophilia include inhalation of antigens, such as demolition dust, cigarette smoke, electronic cigarettes, cannabis, crack cocaine; parasitic and fungal infections; HIV infection; previous irradiation of the chest; and recent use of drugs associated with pulmonary eosinophilia, such as ranitidine, venlafaxine, infliximab, phenytoin, nitrofurantoin, beta-lactam antibiotics, sulfazalazine-mesalazine, among others. Differential diagnosis includes acute interstitial pneumonia, cryptogenic organizing pneumonia, diffuse alveolar hemorrhage and granulomatosis with polyangiitis. These conditions have similar clinical presentations but without pulmonary eosinophilia. Sulfonamide-induced AEP is described as the cause of severe acute respiratory distress syndrome (ARDS).(4-6) Right ventricle failure (RVF) due to acute pulmonary hypertension may occur in up to 25% of severe ARDS patients.(7) Nitric oxide and veno-venous extracorporeal membrane oxygenation (VV-ECMO) support are therapeutic options, but little has been discussed about further options in refractory cases.(4-6) Here, we describe the use of balloon atrial septostomy(8) – a procedure currently indicated in venoarterial ECMO (VA-ECMO) for left ventricle decompression – as a possible rescue therapy for RVF.","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High mortality in Brazilian intensive care units can be a problem of laws rather than a technical one: focus on sedation practices.","authors":"Cassiano Teixeira","doi":"10.5935/2965-2774.20230337-en","DOIUrl":"10.5935/2965-2774.20230337-en","url":null,"abstract":"In the care of ventilated critically ill patients, there is a consistent relationship between deeper sedation and worse intensive care unit (ICU) outcomes.(1,2) Deep sedation in the first 48 hours of an ICU stay has been associated with delayed time to extubation, higher need for tracheostomy, longer ICU stays, and increased risk of hospital and long-term death.(3) This association in patients with acute respiratory distress syndrome (ARDS) and other severely ill patients is of particular concern. In this sense, perhaps the greatest advances in critical patient care can be summarized by the ABCDEF bundle in critical care (Assess, prevent, and manage pain; Both spontaneous awakening trials and spontaneous breathing trials; Choice of analgesia and sedation; Delirium—assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment); in this approach, light sedation as opposed to deep sedation seems to be preferred.(4,5) Each individual component of the bundle is evidence-based and has been validated in multiple clinical trials. The bundle combines the individual impact of each intervention into a synergistic process of care that improves ICU outcomes and can mitigate the burden of postintensive care unit syndrome in survivors. Authors have already demonstrated improving both short-term need (length of delirium, need for physical restraints, days on mechanical ventilation) and long-term outcomes (ICU readmission, discharge to facility) in critically ill patients when these recommendations are practiced.(4) In recent years, high-income countries have shown an important reduction in the mortality of critically ill patients, a fact that has not been replicated in lowand middle-income countries. However, why does it not occur? Let us evaluate critical illness data in Brazil, a continental and multicultural country that has failed systematically to reduce critical illness, morbidity and mortality. Recent well-conducted randomized clinical trials (RCTs) in Brazil(6,7) have demonstrated the inability of some clinical teams to achieve the internationally recommended goals of light sedation. The CHECKLIST trial(6) (n = 6,877), including any patients admitted to adult ICUs, showed low adherence (control group, 35.0% versus intervention group, 40.5%, p = 0.05) of the ICU staff in providing moderate sedation to alert and calm patients (Richmond Agitation-Sedation Scale RASS -3 to 0). Patient ́s in-hospital mortality (truncated at 60 days) was 33.9% (mean Simplified Acute Physiology Score 3 SAPS 3 at admission, 51.2 [standard deviation SD, 17.9] in the control group and 54.2 [SD, 17.5] in the intervention group). Another RCT, the Acute Respiratory Distress Syndrome Trial (ART)(7) (n = 1,010), which evaluated patients with moderate to severe ARDS, showed that 96.8% of the control group and 73.3% of the intervention group (p < 0.001) needed neuromuscular blockage (a proxy of deep sedation practice), with a global patient mortality of ","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study.","authors":"Franciani Rodrigues da Rocha,&nbsp;Renata Casagrande Gonçalves,&nbsp;Gabriele da Silveira Prestes,&nbsp;Danusa Damásio,&nbsp;Amanda Indalécio Goulart,&nbsp;Andriele Aparecida da Silva Vieira,&nbsp;Monique Michels,&nbsp;Maria Inês da Rosa,&nbsp;Cristiane Ritter,&nbsp;Felipe Dal-Pizzol","doi":"10.5935/2965-2774.20230422-en","DOIUrl":"10.5935/2965-2774.20230422-en","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors associated with long-term neuropsychiatric outcomes, including biomarkers measured after discharge from the intensive care unit.</p><p><strong>Methods: </strong>A prospective cohort study was performed with 65 intensive care unit survivors. The cognitive evaluation was performed through the Mini-Mental State Examination, the symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder was evaluated using the Impact of Event Scale-6. Plasma levels of amyloid-beta (1-42) [Aβ (1-42)], Aβ (1-40), interleukin (IL)-10, IL-6, IL-33, IL-4, IL-5, tumor necrosis factor alpha, C-reactive protein, and brain-derived neurotrophic factor were measured at intensive care unit discharge.</p><p><strong>Results: </strong>Of the variables associated with intensive care, only delirium was independently related to the occurrence of long-term cognitive impairment. In addition, higher levels of IL-10 and IL-6 were associated with cognitive dysfunction. Only IL-6 was independently associated with depression. Mechanical ventilation, IL-33 levels, and C-reactive protein levels were independently associated with anxiety. No variables were independently associated with posttraumatic stress disorder.</p><p><strong>Conclusion: </strong>Cognitive dysfunction, as well as symptoms of depression, anxiety, and posttraumatic stress disorder, are present in patients who survive a critical illness, and some of these outcomes are associated with the levels of inflammatory biomarkers measured at discharge from the intensive care unit.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects.","authors":"José Augusto Santos Pellegrini,&nbsp;Ciro Leite Mendes,&nbsp;Paulo César Gottardo,&nbsp;Khalil Feitosa,&nbsp;Josiane França John,&nbsp;Ana Cláudia Tonelli de Oliveira,&nbsp;Alexandre Jorge de Andrade Negri,&nbsp;Ana Burigo Grumann,&nbsp;Dalton de Souza Barros,&nbsp;Fátima Elizabeth Fonseca de Oliveira Negri,&nbsp;Gérson Luiz de Macedo,&nbsp;Júlio Leal Bandeira Neves,&nbsp;Márcio da Silveira Rodrigues,&nbsp;Marcio Fernando Spagnól,&nbsp;Marcus Antonio Ferez,&nbsp;Ricardo Ávila Chalhub,&nbsp;Ricardo Luiz Cordioli","doi":"10.5935/2965-2774.20230310-en","DOIUrl":"10.5935/2965-2774.20230310-en","url":null,"abstract":"<p><p>Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.</p>","PeriodicalId":72721,"journal":{"name":"Critical care science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10321440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}