Hemodynamics Management

Portal vein Doppler with normal D and S waves

Portal vein Doppler with mild variability

renal vein Doppler with discontinuous biphasic flow

@Ibrahim Ameen

The Precision Resuscitation With Crystalloids in Sepsis (PRECISE) Trial: A Trial Protocol | Critical Care Medicine | JAMA Network Open | JAMA Network

The PRECISE trial aims to assess whether an electronic health record (EHR) alert recommending balanced crystalloids over normal saline for patients with group D sepsis reduces 30-day inpatient mortality. This pragmatic, randomized trial uses a machine learning algorithm to identify patients with a sepsis subphenotype (group D), previously shown to benefit from balanced crystalloids. The trial, conducted across multiple hospitals, could significantly influence sepsis resuscitation guidelines by introducing a precision medicine approach.

The group D sepsis sub-phenotype is characterized by lower body temperature, heart rate, and respiratory rate, along with hypotension. Patients in this group are typically older and show higher vasopressor use. Importantly, group D has a significantly higher 30-day mortality risk. However, in the SMART trial, group D patients experienced a substantial reduction in mortality when treated…

This screenshot you provided shows the monitor of an Impella CP which appears to be positioned in the aorta instead of the correct position within the left ventricle (LV).

• Ao Pressure: 126/73 mmHg (Mean 93 mmHg), indicating the device is picking up aortic pressure signals.

• LV Pressure: There is a loss of clear pressure signals from the left ventricle, which would normally be used to monitor proper positioning.

• The low fluctuation of the motor current, (with readings showing a current of 399/350 mA), suggests that there is minimal pressure gradient across the two pressure sensors of the Impella device. These sensors normally detect pressure differences between the aorta and the left ventricle.

The motor current stability (almost flat) suggests that the Impella is likely not in the left ventricle (as intended) but rather in the aorta. Since both sensors are exposed to aortic pressure, there is little to no pressure gradient detected…