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Hemodynamic monitoring in cardiogenic shock

Journal of Intensive Medicine 2023年第2期3卷 104-113页

作者： Olfa Hamzaoui florence boissier Service de Médecine Intensive Réanimation Hopital Robert DebréUniversitéde ReimsReims 51092France UnitéHERVI Hémostase et Remodelage Vasculaire Post-IschémieEA 3801Reims 51092France Médecine Intensive Réanimation H?pital Universitaire de PoitiersPoitiers 90577France INSERM CIC 1402(ALIVE Group) Universitéde PoitiersPoitiers 90577France

Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to *** diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume ***,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic *** monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical *** is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient *** more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce *** this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.

关键词： Echocardiography Cardiogenic shock Hemodynamic monitoring Pulmonary artery catheter Transpulmonary thermodilution device

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Septic cardiomyopathy: Diagnosis and management

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Journal of Intensive Medicine 2022年第1期2卷 8-16页

作者： florence boissier Nadia Aissaoui Service de Médecine Intensive Réanimation CHU de PoitiersPoitiers 86021France Universitéde Poitiers Poitiers INSERM CIC 1402(ALIVE group)France Service de Médecine Intensive Réanimation Hôpital CochinAPHPParis 75014France Universitéde Paris Paris Cardiovascular Research CenterINSERM U970Paris 75015France

There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been *** may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular *** should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require *** is currently the gold standard for diagnosis of *** ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial ***,repeated echocardiography evaluation is *** of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and *** of inotropes remains uncertain,and heart rate control could be an option in some patients.

关键词： Septic shock Myocardial dysfunction Echocardiography Septic cardiomyopathy

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Small renal masses in kidney transplantation:Overview of clinical impact and management in donors and recipients

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Asian Journal of Urology 2022年第3期9卷 208-214页

作者： Alberto Piana Iulia Andras Pietro Diana Paolo Verri Andrea Gallioli Riccardo Campi Thomas Prudhomme Vital Hevia Romain boissier Alberto Breda Angelo Territo Department of Urology Fundacio PuigvertAutonoma University of BarcelonaSpain Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoTurinItaly Urology Department Iuliu Hatieganu University of Medicine and Pharmacy and Municipal HospitalCluj-NapocaRomania Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly Department of Experimental and Clinical Medicine University of FlorenceFlorenceItaly Department of Urology and Kidney Transplantation Toulouse University HospitalToulouseFrance Hospital Universitario Ramon y Cajal.Alcala University Instituto Ramon y Cajal de Investigacion Sanitaria(IRYCIS)MadridSpain Aix-Marseille universite service de chirurgie urologique et de transplantation renaleCHU ConceptionAP-HMMarseilleFrance

Kidney transplantation is the best replacement treatment for the end-stage renal ***,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this *** expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal *** narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or *** to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in *** the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal ***,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.

关键词： Small renal mass Renal cancer Kidney transplantation Nephron-sparing treatment

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