Person: Mercado, Pablo
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Mercado
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Pablo
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Pablo Vladimir Mercado Irribarren
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Publication Mitral annular plane systolic excursion for assessing left ventricular systolic dysfunction in patients with septic shock(2023) Mercado, Pablo; Brault, Clément; Zerbib, Yoann; Diouf, Momar; Michaud, Audrey; Tribouilloy, Christophe; Maizel, Julien; Slama, MichelBackground: Using easy-to-determine bedside measurements, we developed an echocardiographic algorithm for predicting left ventricular ejection fraction (LVEF) and longitudinal strain (LVLS) in patients with septic shock. Methods: We measured septal and lateral mitral annular plane systolic excursion (MAPSE), septal and lateral mitral S-wave velocity, and the left ventricular longitudinal wall fractional shortening in patients with septic shock. We used a conditional inference tree method to build a stratification algorithm. The left ventricular systolic dysfunction was defined as an LVEF <50%, an LVLS greater than -17%, or both. Results: We included 71 patients (males: 61%; mean [standard deviation] age: 61 [15] yr). Septal MAPSE (cut-off: 1.2 cm) was the best predictor of left ventricular systolic dysfunction. The level of agreement between the septal MAPSE and the left ventricular systolic dysfunction was 0.525 [0.299-0.751]. A septal MAPSE ≥1.2 cm predicted normal LVEF in 17/18 patients, or 94%. In contrast, a septal MAPSE <1.2 cm predicted left ventricular systolic dysfunction with impaired LVLS in 46/53 patients (87%), although 32/53 (60%) patients had a preserved LVEF. Conclusions: Septal MAPSE is easily measured at the bedside and might help clinicians to detect left ventricular systolic dysfunction early-especially when myocardial strain measurements are not feasible.Publication Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis(2022) Gavelli, Francesco; Shi, Rui; Teboul , Jean-Louis; Azzolina, Danila; Mercado, Pablo; Jozwiak, Mathieu; Chew, Michelle; Huber, Wolfgang; Y Kirov, Mikhail; V Kuzkov, Vsevolod; Lahmer, Tobias; Malbrain, Manu; Mallat, Jihad; Sakka, Samir; Tagami, Takashi; Pham, Tài; Monnet , XavierBackground: The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients. Methods: Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity. Results: Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], p < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of -4.97 mL/kg (95% CI [-6.54; -3.41], p < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses. Conclusions: The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence. Trial registration the study protocol was prospectively registered on PROSPERO: CRD42019126985Publication Lung recruitment maneuver improves right and left ventricular function in patients with acute respiratory distress syndrome(2025) Lambour, Alexis; Zerbib, Yoann; Mercado, Pablo; Kontar, Loay; De Cagny, Bertrand; Maizel, Julien; Slama, Michel; Brault, ClémentBACKGROUND: Lung recruitment maneuvers (LRM) and high positive end-expiratory pressure (PEEP) may benefit some patients by reopening non- or poorly aerated alveoli. However, the effects of opening the lung with LRM on hemodynamics remain uncertain. This study aimed to evaluate the direct impact of LRM on cardiac function in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). METHODS: This post-hoc analysis included 34 patients with moderate-to-severe ARDS from two prospective cohort studies. The LRM consisted in a gradual increase in PEEP, starting from 25 cmH2O (PEEPpre, before the recruitment maneuver at PEEP 25 cmH2O) until reaching 40 cmH2O. After LRM, PEEP was decreased to 25 cmH2O (PEEPpost, after the recruitment maneuver, also at PEEP 25 cmH2O) followed by a decremental PEEP titration. We compared the size and function of the right ventricle (RV) and left ventricle (LV) between PEEPpre and PEEPpost. RESULTS: The respiratory system compliance significantly increased from 21 ± 7 ml/cmH2O at PEEPpre to 24 ± 7 ml/cmH2O at PEEPpost (p < 0.001), indicating effective lung recruitment. The RV end-diastolic diameter and the RV/LV ratio decreased after LRM (51 ± 11 vs. 41 ± 9 mm; p < 0.001, and 1.05 ± 0.21 vs. 0.90 ± 0.18; p < 0.001, respectively), suggesting reduced pulmonary vascular resistance. The RV free wall strain improved from -22 ± 10 to -25 ± 8% (p = 0.040). The cardiac index significantly increased from 2.1 ± 0.6 to 2.4 ± 0.7 L/min/m2 (p < 0.001) due to improved LV function, as demonstrated by a lower LV global longitudinal strain at PEEPpost (-16 ± 4% vs. -19 ± 3%, p = 0.002). CONCLUSIONS: LRM may benefit both the lungs and the heart. The increase in transpulmonary pressure leads to an expansion in aerated lung volume, potentially reducing lung overdistension and collapse, thereby lowering RV afterload and improving RV systolic function.