Frederic Michard

Several artificial intelligence (AI)-driven tools have emerged for the hemodynamic evaluation of critically ill and surgical patients. This article provides an overview of current developments and potential clinical applications of machine learning (ML) for blood pressure measurements, hypotension prediction, hemodynamic profiling, and echocardiogr...

The advancements in cardiovascular imaging over the past two decades have been significant. The miniaturization of ultrasound devices has greatly contributed to their widespread adoption in operating rooms and intensive care units. The integration of AI-enabled tools has further transformed the field by simplifying echocardiographic evaluations and...

The early detection of clinical deterioration could be the next significant step in enhancing patient safety in general hospital wards. Most patients do not deteriorate suddenly; instead, their vital signs are often abnormal or trending towards an abnormal range hours before severe adverse events requiring rescue intervention and/or ICU transfer. T...

During surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery – and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous...

Both over and underdamping of the arterial pressure waveform are frequent during continuous invasive radial pressure monitoring. They may influence systolic blood pressure measurements and the accuracy of cardiac output monitoring with pulse wave analysis techniques. It is therefore recommended to regularly perform fast flush tests to unmask abnorm...

Purpose In patients with a radial arterial catheter, underdamping of the pressure signal is common and responsible for an overestimation of systolic arterial pressure (SAP). The maximum rate of the arterial pressure rise during systole (dP/dt MAX ) has been proposed to assess left ventricular systolic function. The impact of underdamping on dP/dt M...

Background: The question of environmentally sustainable perioperative medicine represents a new challenge in an era of cost constraints and climate crisis. The French Society of Anaesthesia and Intensive Care (SFAR) recommends stroke volume optimization in high-risk surgical patients. Pulse contour techniques have become increasingly popular for s...

We prospectively studied patients who required an echocardiographic evaluation during their ICU stay and in whom it was possible to obtain transthoracic images with a cart-based high-end ultrasound device (institutional review board approval # TI 71/2021). LVEFSMART measurements were taken with a software application (Butterfly IQ - Ultrasound, But...

The analysis of arterial pressure waveforms with machine learning algorithms has been proposed to predict intraoperative hypotension. The ability to forecast arterial hypotension 5-15 min ahead of the fall in blood pressure allows clinicians to be pro-active instead of reactive, and could potentially decrease postoperative morbidity. However, the p...

Abstract Background Machine learning algorithms have recently been developed to enable the automatic and real-time echocardiographic assessment of left ventricular ejection fraction (LVEF) and have not been evaluated in critically ill patients. Methods Real-time LVEF was prospectively measured in 95 ICU patients with a machine learning algorithm in...

Artificial intelligence (AI) tools have recently been developed to facilitate, automate, and decrease the intra-operator variability of echocardiographic measurements.5e8 One of these AI-enabled tools has been developed specifically for automatic assessment of VTI (autoVTI) in just a few seconds. Using colour-coding, auto-VTI enables the correct po...

Background Several continuous monitoring solutions, including wireless wearable sensors, are available or being developed to improve patient surveillance on surgical wards. We designed a survey to understand the current perception and expectations of anaesthesiologists who, as perioperative physicians, are increasingly involved in postoperative car...

A wireless and wearable system was recently developed for mobile monitoring of respiratory rate (RR). The present study was designed to compare RR mobile measurements with reference capnographic measurements on a medical-surgical ward. The wearable sensor measures impedance variations of the chest from two thoracic and one abdominal electrode. Simu...

We compared blood pressure (BP) values obtained with a new optical smartphone application (OptiBP™) with BP values obtained using a non-invasive automatic oscillometric brachial cuff (reference method) during the first 2 h of surveillance in a post-anesthesia care unit in patients after non-cardiac surgery. Three simultaneous BP measurements of bot...

Objective: The non-invasive estimation of central systolic blood pressure (cSBP) is increasingly performed using new devices based on various pulse acquisition techniques and mathematical analyses. These devices are most often calibrated assuming that mean (MBP) and diastolic (DBP) BP are essentially unchanged when pressure wave travels from aorta...

Background Pulmonary artery thermodilution is the clinical reference method for cardiac output monitoring. Because both continuous and intermittent pulmonary artery thermodilution are used in clinical practice it is important to know whether cardiac output measurements by the two methods are clinically interchangeable. Methods We performed a syste...

Background: Although fluid administration is a key strategy to optimise haemodynamic status and tissue perfusion, optimal fluid administration during liver surgery remains controversial. Objective: To test the hypothesis that a goal-directed fluid therapy (GDFT) strategy, when compared with a conventional fluid strategy, would better optimise sy...

Smartphones are increasingly powerful computers that fit in our pocket. Thanks to dedicated applications or "Apps," they can connect with external sensors to record, analyze, display, store, and share multiple physiologic signals and data. In addition, because modern smartphones are equipped with accelerometers, gyroscopes, cameras, and pressure se...

For decades, the hemodynamic assessment of critically ill patients relied almost exclusively on invasive dilution techniques and on echocardiographic evaluations done with cumbersome devices. Things dramatically changed over the last decade with the development of less invasive blood pressure and cardiac output monitoring techniques and the miniatu...

Continuous and mobile monitoring of vital signs may soon become a reality on hospital wards. By enabling the early detection of clinical deterioration, it may improve quality of care and patient safety.

In the original publication of the article, the section heading “Conclusion” was placed before the sentence “The assessment of changes in cardiac output…” in page 2 instead of the sentence “From home to ICUs, innovations in…” in the last paragraph of the page 2. The correct section is given below:

Strain echocardiography enables the automatic quantification of the global longitudinal strain (GLS), which is a direct measure of ventricular shortening during systole. In the current context of overwhelmed ICUs and clinician shortage, GLS has the advantage to be quick and easy to measure by non-experts. However, little is known regarding its valu...

Changes in stroke volume (deltaSV) induced by a lung recruitment manoeuvre (LRM) have been shown to accurately predict fluid responsiveness during protective mechanical ventilation. Cardiac output monitors are used in a limited number of surgical patients. In contrast, all patients are monitored with a pulse oximeter, that may enable the continuous...

Purpose To survey haemodynamic monitoring and management practices in ICU patients with the coronavirus disease 2019 (COVID-19). Methods A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists...

From home to intensive care units, innovations in pulse oximetry are susceptible to improve the monitoring and management of patients developing acute respiratory failure, and particularly those with the coronavirus disease 2019 (COVID-19). They include self-monitoring of oxygen saturation (SpO2) from home, continuous wireless SpO2 monitoring on ho...

Smartphones and mobile devices using wireless internet are used ubiquitously today. The “internet of things” interconnects sensors in everyday objects with mobile and other computing devices via the internet, giving access to a multitude of new data sources. This provides the basis for monitoring and recording physiologic information on mobile devi...

Objectives: Detecting instantaneous stroke volume change in response to altered cardiac preload is the physiologic foundation for determining preload responsiveness. Design: Proof-of-concept physiology study. Setting: Research simulation laboratory. Subjects: Twelve healthy volunteers. Interventions: A wireless continuous wave Doppler ultr...

Given the number of clinical studies and meta-analyses investigating the impact of cardiac output-guided hemodynamic management on the postoperative outcome of patients undergoing high-risk surgery, clinicians should already have a fair idea of the clinical and economic benefits. However, this is still a matter of debate, there are still large outc...

Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure...

Postoperative complications within 30 days represent the third leading cause of death in the world. Multiple solutions have been proposed to tackle the clinical and economic burden of postoperative complications. They include the optimal fluid and hemodynamic management of patients undergoing major surgery. Technological innovations and a better un...

p>Background: Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target popu...

Several techniques are now available to detect and quantify pulmonary edema, from the laboratory postmortem method (gravimetry) to non-invasive wearable sensors. In critically ill patients with adult respiratory distress syndrome (ARDS), computed tomography scans are often performed to visualize lung lesions and quantify lung aeration, but their va...

Background Perioperative arterial blood pressure management is a physiologically complex challenge influenced by multiple factors. Methods A multidisciplinary, international working subgroup of the Third Perioperative Quality Initiative (POQI) consensus meeting reviewed the (patho)physiology and measurement of arterial pressure as applied to perio...

Most hemodynamic monitoring techniques have an associated cost. Although difficult to quantify, the cost of their implementation may be significant, particularly for techniques requiring prolonged high-level training, such as echocardiography. These costs, or upfront investments, may be an obstacle to hospital adoption. Importantly, a fair evaluati...

Fluid administration leads to a significant increase in cardiac output in only half of the intensive care unit patients. This led to the concept of assessing fluid responsiveness before infusing fluid. Pulse pressure variation, which quantifies the changes in arterial pulse pressure during mechanical ventilation, is one of the dynamic variables whi...

Smartphones and electronic tablets (e-tablets) have become ubiquitous devices. Their ease of use, smartness, accessibility, mobility and connectivity create unique opportunities to improve quality of surgical care from prehabilitation to rehabilitation. Before surgery, digital applications (Apps), serious games and text messaging may help for a bet...

Previous meta-analyses suggest that perioperative goal-directed therapy (GDT) is useful to decrease postoperative morbidity. Most GDT studies analysed were done with pulmonary artery catheters, oesophageal Doppler and calibrated pulse contour methods. Uncalibrated pulse contour (uPC) techniques are an appealing alternative but their accuracy has be...

Enhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs—a key determinant of success—remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs. Preoperative physical condition, a major determinan...

Many mobile phone or tablet applications have been designed to control cardiovascular risk factors (obesity, smoking, sedentary lifestyle, diabetes and hypertension) or to optimize treatment adherence. Some have been shown to be useful but the long-term benefits remain to be demonstrated. Digital stethoscopes make easier the interpretation of abnor...

Digital innovations are changing medicine, and hemodynamic monitoring will not be an exception. Five to ten years from now, we can envision a world where clinicians will learn hemodynamics with simulators and serious games, will monitor patients with wearable or implantable sensors in the hospital and after discharge, will use medical devices able...

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 us...

Background Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17–29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy. Methods We stu...

Background: Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17-29 % decrease in postoperative morbidity with goal-directed fluid therapy. Our objective was to estimate the potential economic impact of perioperative goal-directed fluid therapy. Methods: We...

The invention relates to a disposable sensor device (51) for patient monitoring comprising a sensor (52) for providing an electric quantity based on a quantity to be detected, a first signal terminal (54) for providing a tap for the electric quantity, a first supply terminal (53) for supplying the sensor with an electrical supply quantity, a first...

IntroductionDynamic 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 i...

IntroductionPay-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...

Patients undergoing surgery may develop postoperative complications. The morbidity rate, defined as the proportion of patients developing at least 1 post-surgical complication, increases in the presence of co-morbidities (patient risk) and with the complexity and duration of the surgical procedure (procedure risk). Morbidity rates are often underes...

A device for infusing of at least one medicament includes at least two actuators configured to cause at least two medicaments to be infused; at least one sensor configured to measure a value of at least two parameters; and a controller configured to control the at least two actuators, wherein the controller is programmed to activate the at least tw...

The way hemodynamic therapies are delivered today in anesthesia and critical care is suboptimal. Hemodynamic variables are not always understood correctly and used properly. The adoption of hemodynamic goal-directed strategies, known to be clinically useful, is poor. Ensuring therapies are delivered effectively is the goal of decision support tools...

Shoemaker et al. [1] were the first to describe the concept of oxygen debt during major surgical procedures and to demonstrate that perioperative hemodynamic optimization has the potential to improve postoperative outcome. Since then, at least 26 other randomized controlled trials (RCTs) [2–27] have shown that perioperative optimization of stroke v...

Th 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...

We 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 optimizati...

To investigate the ability of a new stroke volume variation algorithm to predict fluid responsiveness during general anesthesia and mechanical ventilation in animals with multiple extrasystoles. Prospective laboratory animal experiment. Investigational laboratory. Eight instrumented pigs. Eight anesthetized and mechanically ventilated pigs were mon...

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 t...