| 1. |
- Bergenzaun, Lill, et al.
(författare)
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Assessing left ventricular systolic function in shock : evaluation of echocardiographic parameters in intensive care
- 2011
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Ingår i: Critical Care. - : BioMed Central. - 1364-8535 .- 1466-609X. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE). METHODS: Fifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI). RESULTS: EBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively). CONCLUSIONS: EBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.
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| 2. |
- Bergenzaun, Lill, et al.
(författare)
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High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care.
- 2012
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Ingår i: BMC Anesthesiology. - : BioMed Central. - 1471-2253 .- 1471-2253. ; 12:25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. METHODS: A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), highsensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (e, a, E/e) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated. RESULTS: hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/e (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and nonsurvivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5). CONCLUSIONS: hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.
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| 3. |
- Bergenzaun, Lill, et al.
(författare)
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Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients : Cardiovascular Ultrasound
- 2013
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Ingår i: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 11:16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome. METHODS: In a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality. RESULTS: MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1-2, 4-6). CONCLUSIONS: MAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.
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| 5. |
- Holst, Marie, 1959-, et al.
(författare)
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Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure
- 2008
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:17, s. 2318-2326
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To describe the self-reported fluid intake and its effects on body weight, signs and symptoms of heart failure, quality of life, physical capacity and thirst, in patients with stabilised chronic heart failure. Background. Patients with chronic heart failure are often recommended a fluid restriction of 1.5 l/day but there is no evidence in the literature for this recommendation and little is known about the fluid intake consequences. Design. Crossover study. Methods. Chronic heart failure patients, clinically stabilised after an unstable state, were randomised to a 32-week cross-over study assessing the clinical importance of fluid prescription. In a secondary analysis of 63 patients, efficacy variables were analysed in relation to the self-reported median fluid intake of 19 ml/kg body weight/day. Results. The mean fluid intake was 16 ml/kg/day in the below-median group and 24 ml/kg/day in the above-median group. No between-group differences were found in change in body weight, signs and symptoms, diuretic use, quality of life or physical capacity. However, the above-median group significantly decreased sense of thirst and difficulties to adhere to the fluid prescription compared with the below-median group. Conclusion. In clinically stabilised chronic heart failure patients on optimal pharmacological treatment, a larger fluid intake was associated with decreasing thirst without any measurable negative effects on signs and symptoms of heart failure, diuretic use or physical capacity. Thus, a more liberal fluid intake may be advisable in chronic heart failure patients who have been stabilised after an initial unstable clinical state. Relevance to clinical practice. Nurses involved in the care for patients with heart failure known how troublesome thirst can be and how difficult it can be to follow a restricted fluid intake. This study indicates that it is possible to reassess and recommend a less strict fluid intake in stabilised patients with chronic heart failure. © 2008 The Authors.
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| 6. |
- Holst, M., et al.
(författare)
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Fluid restriction in heart failure patients : Is it useful? The design of a prospective, randomised study
- 2003
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier Science. - 1474-5151 .- 1873-1953. ; 2:3, s. 237-242
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Tidskriftsartikel (refereegranskat)abstract
- Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non-pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks. © 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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| 7. |
- Holst, Marie, 1959-, et al.
(författare)
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Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure : Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity
- 2008
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 42:5, s. 316-322
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the effects of a restrictive versus a liberal fluid prescription, on quality of life, physical capacity, thirst and hospital admissions, in patients who had improved from NYHA class (III-)IV CHF to a stable condition without clinical signs of significant fluid overload. Design. The present study is a randomised cross-over study. Seventy-four patients (mean age 70±10 years, 16% women) - with mild-moderate CHF - were randomised 1:1 to either of two 16-week interventions. Intervention 1 prescribed a maximum fluid intake of 1.5 L/day. Intervention 2 prescribed a maximum fluid intake of 30-35 ml/kg body weight/day. Sixty-five patients completed the study. Results. There were no significant between-intervention differences in end-of-intervention quality of life, physical capacity or hospitalisation. However, there was a significant favourable effect on thirst and less difficulties to adhere to the fluid prescription during the liberal fluid prescription intervention. Conclusion. The results from this study indicate that it may be beneficial and safe to recommend a liberal fluid prescription, based on body weight, in stabilised CHF patients. These results warrant further investigation of the effects of fluid advice in CHF. © 2008 Informa UK Ltd.
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| 8. |
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| 9. |
- Mårtensson, Jan, et al.
(författare)
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Nurse-led heart failure follow-up in primary care in Sweden
- 2009
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Ingår i: EUROPEAN JOURNAL OF CARDIOVASCULAR NURSING. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 8:2, s. 119-124
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little or no knowledge is available about which service is offered to patients with heart failure in primary care. Aims: To describe nurse-led follow-up of patients with heart failure in primary care in Sweden. Methods and results: A questionnaire was sent to all primary health care centres in Sweden and 6 10 of 939 centres returned the questionnaire. Special nurses had designated time for follow-up of heart failure patients at 18% (n = 111) of the centres, compared to 93% and 78% for diabetes and obstructive lung disease. Centres with nurse-led follow-up of heart failure patients more frequently provided heart failure information (pandlt;0.001), had more doctors interested in heart failure (pandlt;0.001), more often had special care programmes (Pandlt;0.001) and had more co-operation with the hospitals around patients with heart failure (pandlt;0.01), compared to centres without such follow-up (n = 499). Conclusion: In primary care in Sweden, nurse-led follow-up is uncommon for patients with heart failure, despite being common for patients with diabetes and obstructive pulmonary disease. To improve this situation in primary care, an increased number of specially trained nurses is needed, together with further research to ensure a high quality follow-up in primary care.
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