Echocardiography

Bouhemad B, Mojoli F, Mongodi S. Intensive Care Med. 2020 Nov;46(11):2123. doi: 10.1007/s00134-020-06239-4. Epub 2020 Sep 28. Share this:     

Authors Mayo PH, Copetti R, Feller-Kopman D, Mathis G, Maury E, Mongodi S, Mojoli F, Volpicelli G, Zanobetti M. Intensive Care Med. 2019 Aug 15. doi: 10.1007/s00134-019-05725-8. [Epub ahead of print] Abstract This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The […]

Silvia Mongodi, Marta Luperto, Emanuela Maria Roldi, Anita Orlando, Giorgio Antonio Iotti, Francesco Mojoli CHEST Volume 155, Issue 1, January 2019, Pages e9-e12 Free full-text and didactic videos freely available until February 23rd at Science Direct   Share this:     

F. Mojoli, S. Mongodi ICU Management & Practice. 2017;17(3):186-9. In the last years, ultrasound (US) became an essential tool in the hands of the intensivist and is now recommended both for procedural guidance and diagnostic purposes. Point-of-care ultrasound (POCUS) is an immediately available and repeatable, non-irradiating bedside tool integrating the clinical examination.   While echocardiography […]

Silvia Mongodi, MD, PhD, Emanuela Maria Roldi, MD, Anita Orlando, MD, Luca Civardi, MD, Giorgio Antonio Iotti, MD, Francesco Mojoli, MD doi.org/10.1016/j.chest.2017.03.066 Free access to full text and didactic videos until October 27th here Share this:     

S. Mongodi, F. Mojoli, G. Via, G. Tavazzi, F. Fava, M. Pozzi, G. A. Iotti, B. Bouhemad

Introduction: Weaning failure (WF) from mechanical ventilation (MV) may be due to lung derecruitment, cardiac dysfunction and respiratory muscles weakness. Transthoracic echocardiography (TTE) [1], lung ultrasound (LUS) [2] and diaphragm ultrasound (DUS) [3] have shown their value in early identification of the failing patients separately. A combination of TTE, LUS and DUS could improve the identification of failing patients and of WF etiology [4]. We aimed to estimate the value of a combined ultrasound assessment (heart-lung-diaphragm) to early identify patients at high risk of WF from MV.

Methods: Prospective observational multicenter international study including all patients undergoing a 30’ spontaneous breathing trial (SBT) before extubation. Patients with neuromuscular diseases and MV <48 hours were excluded. TTE and LUS were performed before SBT and at its end; DUS at beginning and end of SBT. TTE included: MAPSE (mitral annulus plane systolic excursion), EF% (ejection fraction), E/A, E/Ea. We computed LUS score (0–36) [2]. DUS assessed diaphragm excursion. Extubation was considered as failed in case of reintubation, non-invasive ventilation or death within 48 hours. We used classical criteria for SBT failure. Extubation was decided by an independent operator.

Results: We enrolled 18 patients (age 77.7 ± 11.4 yrs, BMI 29.9 ± 7, SAPSII 54.4 ± 17.4, MV length 9.5 ± 7.3 days). 6 patients (33%) failed the SBT and were not extubated. 12 patients (67%) were extubated; 5 failed. Two populations were identified: WF (failed SBT or extubation) and weaning success (WS). LUS: SBT-LUS was higher than MVLUS in the whole population (17 ± 4 vs. 12 ± 3; p = 0.019); this was more remarkable in WF (20 ± 3 vs. 11 ± 3; p = 0.0004). SBT-LUS was higher in WF vs. WS (20 ± 3 vs. 13 ± 4; p = 0.03). SBT-LUS predicted SBT and weaning failure (respectively AUC 0,877 and AUC 0,883). TTE: E/A and E/Ea (both MW and SBT) did not predict WF, extubation failure nor SBT-failure. MV-MAPSE predicted WF (AUC 0,833); if < =10 mm it predicted WF with sensitivity 0.67 and specificity 1. SBTMAPSE predicted extubation failure (AUC 0.833). DUS: No correlation between diaphragm excursion and WF was identified.

Conclusions: LUS and MAPSE seem to be the most useful parameters to predict weaning failure.

References 1. Caille et al., Crit Care 2010 2. Soummer et al., Crit Care Med 2012 3. Kim et al., CCM 2011 4. Mongodi et al., Crit Care Med 2013

Grant The research project received the ESICM Clinical Research Award 2015.

Pag. 30 From Critical Care

Mongodi S, Orlando A, Tavazzi G, Pozzi M, Maggio G, Braschi A, Iotti GA, Mojoli F. J Cardiothorac Vasc Anesth. 2016 Dec 7. pii: S1053-0770(16)30659-0. doi: 10.1053/j.jvca.2016.12.007.   From Pubmed Share this:     

Mongodi S, Via G, Riccardi M, Tavazzi G, D’Armini AM, Maurelli M, Braschi A, Mojoli F. J Clin Ultrasound. 2016 Jul 22. doi: 10.1002/jcu.22383. Abstract Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory […]

F. Mojoli, A. Orlando, S. Mongodi, A. Braschi   Chest. 2016; 149(5):e137-e139. doi: 10.1016/j.chest.2015.11.033 Full text from CHEST online first   Share this:     

Mongodi S, Via G, Bouhemad B, Storti E, Mojoli F, Braschi A. Abstract OBJECTIVE: Recognition of the cardiac origin of weaning failure is a crucial issue for successful discontinuation of mechanical ventilation. Bedside lung ultrasound and echocardiography have shown a potential in predicting weaning failure. Objective of this report was to describe the case of […]