Journal ArticleDOI
Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome.
Daniel De Backer,Katia Donadello,Yasser Sakr,Gustavo A. Ospina-Tascón,Diamantino Salgado,Sabino Scolletta,Jean Louis Vincent +6 more
TLDR
Microcirculatory alterations are stronger predictors of outcome than global hemodynamic variables in patients with severe sepsis.Abstract:
Objectives: Sepsis induces microvascular alterations that may play an important role in the development of organ dysfunction. However, the relationship of these alterations to systemic variables and outcome is still not well defined. We investigated which factors may influence microcirculatory alterations in patients with severe sepsis and whether these are independently associated with mortality. Design: Analysis of prospectively collected data from previously published studies by our group. Setting: A 36-bed, medicosurgical university hospital Department of Intensive Care. Patients: A total of 252 patients with severe sepsis in whom the sublingual microcirculation was visualized using orthogonal polarization spectral or sidestream darkfield imaging techniques. Measurements and Main Results: Microcirculatory measurements were obtained either early, within 24 h of the onset of severe sepsis (n = 204), or later, after 48 h (n = 48). When multiple measurements were obtained, only the first was considered. Although global hemodynamic variables were relatively preserved (mean arterial pressure 70 [65–77] mm Hg, cardiac index 3.3 [2.7–4.0] L/min.m 2 , and Svo 2 68.3 [62.8–74.7]%),read more
Citations
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Journal ArticleDOI
Micro- and Macrocirculatory Changes During Sepsis and Septic Shock in a Rat Model.
Tianfeng Hua,Xiaobo Wu,Wei Wang,Hao Li,Jennifer Bradley,Mary Ann Peberdy,Joseph P. Ornato,Wanchun Tang,Wanchun Tang +8 more
TL;DR: In the rat model of peritonitis-induced sepsis, microcirculatory alterations of both peripheral mucosa and kidney occurred earlier than global hemodynamics, and monitoring the microcirculation may provide a means of early detection of circulatory failure during septic shock.
Book ChapterDOI
Multiple Organ Dysfunction
TL;DR: Critical illness represents a dynamic process where multiple pathways are simultaneously affected and marked fluctuations occur over time, and MODS may represent an adaptive response early in critical illness, which may become maladaptive with inadequate cellular functionality to sustain life.
Journal ArticleDOI
Observational study of the effects of traumatic injury, haemorrhagic shock and resuscitation on the microcirculation: a protocol for the MICROSHOCK study
TL;DR: The aim of the MICROSHOCK study is to investigate changes seen in the microcirculation of patients following traumatic haemorrhagic shock, and to assess its response to resuscitation.
Journal ArticleDOI
Venous-arterial CO2 to arterial-venous O2 difference ratio as a resuscitation target in shock states?
TL;DR: It is proposed that the Cmv–aCO2/Ca–mvO2 could become a resuscitation target and the relationship between CO2 content and PCO2 is curvilinear rather than linear and is influenced by the degree of metabolic acidosis, the hematocrit and the O2 saturation.
Journal ArticleDOI
Fluid Resuscitation and Markers of Glycocalyx Degradation in Severe Sepsis.
TL;DR: In patients with severe sepsis, the glycocalyx plays an important role in liquid distribution in different phases, and at present, lactate clearance has greater diagnostic value than plasma syndecan-1 concentrations in severesepsis.
References
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R. P. Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more
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The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
Jean Louis Vincent,R. Moreno,Jukka Takala,Sheila Willatts,A. de Mendonça,Hajo A. Bruining,C. K. Reinhart,P. M. Suter,L. G. Thijs +8 more
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Mitchell M. Levy,Mitchell P. Fink,John C. Marshall,Edward Abraham,Derek C. Angus,Deborah J. Cook,Jonathan M. Cohen,Steven M. Opal,Jean Louis Vincent,Graham Ramsay +9 more
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APACHE II-A Severity of Disease Classification System: Reply
TL;DR: The form and validation results of APACHE II, a severity of disease classification system, are presented, showing an increasing score was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals.
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Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
R. P. Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more