Frédéric Michard

Learn More
According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling(More)
INTRODUCTION Several studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome. This goal could be achieved simply by minimizing the variation in arterial pulse pressure (deltaPP) induced by mechanical ventilation. We tested this hypothesis in(More)
INTRODUCTION Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are(More)
In anesthetized patients without cardiac arrhythmia the arterial pulse pressure variation (PPV) induced by mechanical ventilation has been shown the most accurate predictor of fluid responsiveness. In this respect, PPV has so far been used mainly in the decision-making process regarding volume expansion in patients with shock. As an indicator of the(More)
PURPOSE Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when(More)
INTRODUCTION A new system has been developed to assess global end-diastolic volume (GEDV), a volumetric marker of cardiac preload, and extravascular lung water (EVLW) from a transpulmonary thermodilution curve. Our goal was to compare this new system with the system currently in clinical use. METHODS Eleven anesthetized and mechanically ventilated pigs(More)
read with interest the commentary by MacDonald and Pearse [1] stating that only large randomized clinical trials (RCTs) can resolve our uncertainty regarding the value of perioperative hemodynamic therapy. Over the past 20 years, more than 20 small to medium size RCTs and several meta-analyses have shown that perioperative hemodynamic optimization improves(More)
e survey by Cannesson and colleagues [1] in the previous issue of Critical Care shows that only around 16% of anesthetists (5.4% of 210 US respondents and 30.4% of 158 European respondents) use a specifi c treatment protocol (that is, follow a goal-directed strategy) for the peri-operative hemodynamic management of patients undergoing high-risk surgery. In(More)
read with interest two recent studies suggesting that pulse pressure variation (PPV) is not an accurate pre-dictor of fl uid responsiveness in subjects with pulmonary hypertension [1,2]. We agree that PPV and stroke volume variation (SVV) may not work in patients with right ventricular (RV) failure. Indeed, when PPV and SVV are related to an inspiratory(More)
INTRODUCTION Pay-for-performance programs and economic constraints call for solutions to improve the quality of health care without increasing costs. Many studies have shown decreased morbidity in major surgery when perioperative goal directed fluid therapy (GDFT) is used. We assessed the clinical and economic burden of postsurgical complications in the(More)