Frederic Michard

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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)
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)
In a recent article about pulse pressure variation (PPV), after 4 pages of physiologic explanations, Dr Sondergaard finally concluded that 'the subject is an exceptional demonstration of physiology but hardly guides the management of critically ill patients' [1]. If I agree with the first part of this statement (I and others spent years dissecting the(More)
Since its first description in 1999 [1], many studies have demonstrated the value of pulse pressure variation (PPV) as a predictor of fluid responsiveness. These studies were pooled together in a recent meta-analysis [2] concluding that PPV predicts fluid responsiveness accurately (sensitivity 88%, specificity 89%), so long as limitations to its use [3,4](More)