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
More filters
Journal ArticleDOI
Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury.
Ning Liu,Zhongheng Zhang,Yucai Hong,Bing Li,Huabo Cai,Hui Zhao,Junru Dai,Lian Liu,Xin Qian,Qicheng Jin +9 more
TL;DR: This study aims to monitor renal microcirculation perfusion during sepsis using contrast-enhanced ultrasonography (CEUS), and to explore whether CEUS is useful for predicting the development of SA-AKI.
Journal ArticleDOI
Early Sequential Microcirculation Assessment In Shocked Patients as a Predictor of Outcome: A Prospective Observational Cohort Study.
Anthony Holley,Anthony Holley,Joel M. Dulhunty,Andrew A. Udy,Mark J. Midwinter,Bill Lukin,Janine Stuart,Robert J. Boots,Robert J. Boots,Melissa Lassig-Smith,Robert B. Holley,Jenny Davida Paratz,Jenny Davida Paratz,Jeffrey Lipman,Jeffrey Lipman +14 more
TL;DR: Early sequential evaluation of the microcirculation in shocked patients demonstrated statistically significant improvement in the PPV and microvascular heterogeneity with standard care, but was not predictive of an improvement in acute kidney injury, length of stay, ICU or hospital mortality.
Journal ArticleDOI
Could resuscitation be based on microcirculation data? No
David N Naumann,Alexandre Lima +1 more
TL;DR: Recent advances in technology that allow for the acquisition of microcirculatory data, such as transcutaneous oximetry, near-infrared spectroscopy (NIRS), and non-invasive handheld video-microscopy (HVM), make this a tantalising prospect.
Journal ArticleDOI
Effects of vasodilators on haemodynamic coherence
TL;DR: There is presently no hard evidence to recommend any vasodilator for routine practice, but inodilators that combine vasodilation with positive inotropy may be promising and microvascular monitoring before and during this therapy is a pre-requisite to indicate and guide vasodilant therapy.
Journal ArticleDOI
Impact of increased mean arterial pressure on skin microcirculatory oxygenation in vasopressor-requiring septic patients: an interventional study
TL;DR: Improvement of microcirculatory oxygenation can be achieved with an increase in mean arterial pressure in most patients, and response to study intervention is proportional to disease severity.
References
More filters
Journal ArticleDOI
APACHE II: a severity of disease classification system.
TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Journal ArticleDOI
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
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
Journal ArticleDOI
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
TL;DR: The ESICM developed a so-called sepsis-related organ failure assessment (SOFA) score to describe quantitatively and as objectively as possible the degree of organ dysfunction/failure over time in groups of patients or even in individual patients.
Journal ArticleDOI
2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
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
TL;DR: This document reflects a process whereby a group of experts and opinion leaders revisited the 1992 sepsis guidelines and found that apart from expanding the list of signs and symptoms of sepsi to reflect clinical bedside experience, no evidence exists to support a change to the definitions.
Journal ArticleDOI
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.
Related Papers (5)
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