Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome.
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Cites background from "Microcirculatory alterations in pat..."
...Several recent studies in septic patients have shown that microcirculatory alterations are closely associated with organ failure and mortality (49, 50),...
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...In addition, several trials have demonstrated an association between the severity of microvascular dysfunction and the development of organ dysfunction (46, 87, 88) and mortality (49, 83, 89)....
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328 citations
327 citations
Cites background or result from "Microcirculatory alterations in pat..."
...Many studies in the literature have described conditions of a loss of hemodynamic coherence where resuscitation resulted in a normalization of systemic hemodynamic variables but did not lead to a parallel improvement in microcirculatory perfusion and oxygenation [10-14]....
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...[10,32] showed in several studies in septic patients that patients with such a type 1 loss of hemodynamic coherence between microcirculatory alterations and systemic hemodynamic variables were associated with adverse outcomes....
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...Clinical studies monitoring sublingual microcirculation using hand-held videomicroscopy have identified the lack of hemodynamic coherence in several studies, a condition associated with increased morbidity and mortality [10-13]....
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292 citations
Cites background from "Microcirculatory alterations in pat..."
...In a large series of 252 patients with septic shock, microvascular perfusion was an independent factor associated with survival.(3) Of note this is not an on-and-off but rather a progressive phenomenon....
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...Recently, alterations in microcirculatory blood flow have been identified in severe sepsis(1) and the severity of these alterations is associated with a poor outcome.(2,3) The impact of therapeutic interventions on microcirculatory function is beginning to be reported....
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...Interestingly, the severity of microvascular alterations was an independent factor associated with outcome in the early and later phases of sepsis, but the cut-off value separating survivors from non-survivors was lower in the early phase.(3) Although one may consider that the microcirculation is just adapting to direct cellular alterations, several factors suggest that microcirculatory alterations are the primary event leading to cellular dysfunction....
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...2).(3) Looking at which variables differed between survivors and non-survivors, the proportion of perfused capillaries was the strongest predictor of outcome....
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References
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"Microcirculatory alterations in pat..." refers methods in this paper
...Acute Physiology and Chronic Health Evaluation II (APACHE II) (23) and Sequential Organ Failure Assessment (SOFA) (24) scores were computed at study inclusion....
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