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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the thoroughly written article of Su&#225;rez et al&#46; regarding the evaluation of diastolic function and dysfunction in the critically ill patient&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Intensivists will greatly benefit from applying these concepts to the individual patient at the bedside&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From a practical perspective&#44; it is interesting to note that evaluating the diastolic dysfunction or&#44; in clearer words based on clinical importance&#44; determining the elevation of left ventricle filling pressures &#40;left atrial pressure in practice&#41;&#44; many times involve many gray or confounding circumstances that preclude its correct diagnosis&#46; For example&#44; this is the case for young patients with supernormal mitral inflow patterns&#44; normal LA volumes despite high LV filling pressures as seen in some patients&#44; acute or chronic severe mitral or aortic valvulopathy&#44; tachyarrhythmia and bradyarrhythmia&#44; improper insonation windows or an incorrect technique&#44; just to mention the most common scenarios&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In all cases&#44; integrating the lung ultrasound to the echocardiogram to complete the evaluation of filling pressures needs to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> This is simply based on determining the presence and amount of B lines as an indicator of extravascular lung water status &#40;lung edema&#41; and pleural effusions as an indicator of sodium and water retention &#40;hypervolemia&#41;&#46; This does not require sophisticated software or a prolonged learning curve<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and is performed in a few minutes with the same phased-array transducer and the preset values used when performing the echocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Besides adding data regarding the status of filling pressures&#44; this is also really interesting when planning therapeutic approaches&#46; For example&#44; a patient with pleural effusions and diffuse B lines in context of high filling pressures is best managed adding diuretics to treatment in contrast to the typical patient with acute hypertensive cardiogenic pulmonary edema crisis&#44; that most of the times is not hypervolemic &#40;e&#46;g&#46; usually lacks pleural effusions&#41; and is predominantly best managed with afterload reduction such as nitrates and&#47;or positive pressure ventilation&#46; This concept can also be applied to a tailored approach of the ultrafiltration volumes in critically ill patients undergoing hemodialysis&#44; reducing or increasing volumes based on the degree of B lines and pleural effusions&#46; In other cases&#44; such as septic patients&#44; when filling pressures are in doubt through transthoracic echocardiogram and predicting fluid responsiveness is not clear &#40;as usually happens in the trenches&#41;&#44; the variation in the number of B lines after a mini-fluid challenge is a useful bedside parameter to guide further fluid therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although B lines and pleural effusions are also seen in pure non-cardiogenic pulmonary edema &#40;i&#46;e&#46; low or normal LV filling pressures&#41; as well as in other conditions such as interstitial lung diseases&#44; their presence&#44; correlating with the whole clinical picture and a focused echocardiogram&#44; allows for the practical intensivist to approach the diagnosis and treatment of filling pressures easily and more accurately&#46;</p></span>"
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        "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">This work has not been presented at any conferences&#46; This work has not been supported by any grants&#46; The author would like to thank Mrs&#46; Julieta Vigna for the language guidance&#46;</p>"
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Letter to the Editor
Lung ultrasound and echocardiography: A useful duet
Ecografía pulmonar y ecocardiografía: un dúo útil
P. Blanco
Intensive Care Unit, Clínica Cruz Azul, Necochea, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the thoroughly written article of Su&#225;rez et al&#46; regarding the evaluation of diastolic function and dysfunction in the critically ill patient&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Intensivists will greatly benefit from applying these concepts to the individual patient at the bedside&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From a practical perspective&#44; it is interesting to note that evaluating the diastolic dysfunction or&#44; in clearer words based on clinical importance&#44; determining the elevation of left ventricle filling pressures &#40;left atrial pressure in practice&#41;&#44; many times involve many gray or confounding circumstances that preclude its correct diagnosis&#46; For example&#44; this is the case for young patients with supernormal mitral inflow patterns&#44; normal LA volumes despite high LV filling pressures as seen in some patients&#44; acute or chronic severe mitral or aortic valvulopathy&#44; tachyarrhythmia and bradyarrhythmia&#44; improper insonation windows or an incorrect technique&#44; just to mention the most common scenarios&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In all cases&#44; integrating the lung ultrasound to the echocardiogram to complete the evaluation of filling pressures needs to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> This is simply based on determining the presence and amount of B lines as an indicator of extravascular lung water status &#40;lung edema&#41; and pleural effusions as an indicator of sodium and water retention &#40;hypervolemia&#41;&#46; This does not require sophisticated software or a prolonged learning curve<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and is performed in a few minutes with the same phased-array transducer and the preset values used when performing the echocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Besides adding data regarding the status of filling pressures&#44; this is also really interesting when planning therapeutic approaches&#46; For example&#44; a patient with pleural effusions and diffuse B lines in context of high filling pressures is best managed adding diuretics to treatment in contrast to the typical patient with acute hypertensive cardiogenic pulmonary edema crisis&#44; that most of the times is not hypervolemic &#40;e&#46;g&#46; usually lacks pleural effusions&#41; and is predominantly best managed with afterload reduction such as nitrates and&#47;or positive pressure ventilation&#46; This concept can also be applied to a tailored approach of the ultrafiltration volumes in critically ill patients undergoing hemodialysis&#44; reducing or increasing volumes based on the degree of B lines and pleural effusions&#46; In other cases&#44; such as septic patients&#44; when filling pressures are in doubt through transthoracic echocardiogram and predicting fluid responsiveness is not clear &#40;as usually happens in the trenches&#41;&#44; the variation in the number of B lines after a mini-fluid challenge is a useful bedside parameter to guide further fluid therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although B lines and pleural effusions are also seen in pure non-cardiogenic pulmonary edema &#40;i&#46;e&#46; low or normal LV filling pressures&#41; as well as in other conditions such as interstitial lung diseases&#44; their presence&#44; correlating with the whole clinical picture and a focused echocardiogram&#44; allows for the practical intensivist to approach the diagnosis and treatment of filling pressures easily and more accurately&#46;</p></span>"
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                        "volumen" => "4"
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        "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">This work has not been presented at any conferences&#46; This work has not been supported by any grants&#46; The author would like to thank Mrs&#46; Julieta Vigna for the language guidance&#46;</p>"
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Article information
ISSN: 21735727
Original language: English
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Medicina Intensiva (English Edition)
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?