ALTERATIONS HEMODYNAMIQUES AU COURS DU SDRA · COURS DU SDRA Antoine Vieillard-Baron, Boulogne,...
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ALTERATIONS HEMODYNAMIQUES AU COURS DU SDRA Antoine Vieillard-Baron, Boulogne, France
Transcript of ALTERATIONS HEMODYNAMIQUES AU COURS DU SDRA · COURS DU SDRA Antoine Vieillard-Baron, Boulogne,...
ALTERATIONS
HEMODYNAMIQUES AU
COURS DU SDRA
Antoine Vieillard-Baron, Boulogne, France
Jama 2010
AJRCCM 2000
98 ARDS ventilés > 48H
72 (73%) avec amines vasoactives
Shock may lead to misinterpretation
of blood gas analysis
• Decrease in pulmonary shunt:
Underestimation of lung injury
Kumar
NEJM 1970
PEEP 13
F. Lemaire, F. Jardin et al. J Thorac Cardiovasc Surg 1978 ; 75 : 839-46
Shock may lead to misinterpretation
of blood gas analysis
• Decrease in pulmonary shunt:
Underestimation of lung injury
• Low PvO2 effect: Overestimation of lung
injury
Shock may lead to misinterpretation
of blood gas analysis
• Decrease in pulmonary shunt:
Underestimation of lung injury
• Low PvO2 effect: Overestimation of lung
injury
• Patent foramen ovale: Overestimation of
lung injury
Crit Care Med 2010
Prevalence 19,2%
Intensive Care Med 2003
• 401 ARDS
– 53% had associated circulatory failure
• 26% in a context of severe sepsis or septic
shock
Am J Respir Crit Care Med 2003
Intensive Care Med 2003
• 401 ARDS
– 53% had associated circulatory failure
• 26% in a context of severe sepsis or septic
shock
• 27% due to “another” mechanism
Am J Physiol Lung Cell Mol Physiol 2012
55.3%
49.3%
N Engl J Med 1977
Crit Care Med 2014
J Appl Physiol 1999
45/200 = 22.5%
49/226 = 22%
19/75 = 25%
Crit Care Med 2001
La défaillance VD a un impact sur
l’hémodynamique
PP = 27%
La défaillance VD a un impact sur le
pronostic
Boissier ICM 2013
Am J Respir Crit Care Med 2010
349/475 = 73%
Multicentric cohort of
752 ARDS with ECHO
EN PRATIQUE
Intensive Care Med 2016
PRISE EN CHARGE DE
L’INSUFFISANCE
CIRCULATOIRE
VENTILATION PROTECTRICE
POUR LA CIRCULATION
PULMONAIRE ET LE VD
Table S3 % of patients with
vasopressors 1 day after randomization
HFO group: 78%
Control group: 58%
20% difference for RV failure?
Crit Care Med 2012
8 pigs
Repeated BAL
ECCO2R (Cardiohelp)
Intensive Care Med 2009
Baseline
T1
PaCO2 52 mmHg 71 mmHg
pH 7.30 7.17
DrivingP 17cmH2O 12cmH2O
RV/LV 0.64 0.85
D1, 10 p.m
PaCO2: 88 mmHg
BD 14 mmol/l
D2, 7 a.m
PaCO2: 55 mmHg
BD 2.3 mmol/l
Duggan M, AJRCCM 2003
Before PP After 18 hours PP
Chest 2007
1996-2006
42 patients
P/F < 100 mmHg
ACP 50%
CATECHOLAMINES
SAP 80 mmHg NE 1µg/kg/min
SAP 110 mmHg
www.echo-rea.uvsq.fr
MERCI
