Journal ArticleDOI
Microvascular Blood Flow Is Altered in Patients with Sepsis
Daniel De Backer,Jacques Creteur,Jean-Charles Preiser,Marc-Jacques Dubois,Jean Louis Vincent +4 more
TLDR
In conclusion, microvascular blood flow alterations are frequent in patients with sepsis and are more severe in Patients with a worse outcome.Abstract:
Microvascular blood flow alterations are frequent in animal models of sepsis and may impair tissue oxygenation. We hypothesized that alterations of the microcirculation are present in patients with sepsis. We used an orthogonal polarization spectral imaging technique to investigate the sublingual microcirculation in 10 healthy volunteers, 16 patients before cardiac surgery, 10 acutely ill patients without sepsis (intensive care unit control subjects), and 50 patients with severe sepsis. The effects of topical application of acetylcholine (10(-2) M) were tested in 11 patients with sepsis. In each subject, five to seven sublingual areas were recorded and analyzed semiquantitatively. Data were analyzed with nonparametric tests and are presented as medians (25th-75th percentiles). No significant difference in microvascular blood flow was observed between healthy volunteers and patients before cardiac surgery or intensive care unit control subjects. The density of all vessels was significantly reduced in patients with severe sepsis (4.5 [4.2-5.2] versus 5.4 [5.4-6.3]/mm in volunteers, p < 0.01). The proportion of perfused small (< 20 microm) vessels was reduced in patients with sepsis (48 [33-61] versus 90 [89-92]% in volunteers, p < 0.001). These alterations were more severe in nonsurvivors. The topical application of acetylcholine totally reversed these alterations. In conclusion, microvascular blood flow alterations are frequent in patients with sepsis and are more severe in patients with a worse outcome.read more
Citations
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Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine
Maurizio Cecconi,Daniel De Backer,Massimo Antonelli,Richard Beale,Jan Bakker,Christoph Hofer,Roman Jaeschke,Alexandre Mebazaa,Michael R. Pinsky,Jean-Louis Teboul,Jean Louis Vincent,Andrew Rhodes +11 more
TL;DR: In this article, the authors provide support to the bedside clinician regarding the diagnosis, management and monitoring of circulatory shock, which is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate.
Journal ArticleDOI
Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock.
TL;DR: Microcirculatory alterations improve rapidly in septic shock survivors but not in patients dying with multiple organ failure, regardless of whether shock has resolved.
Journal ArticleDOI
The microcirculation is the motor of sepsis
TL;DR: In sepsis, where inflammation-induced autoregulatory dysfunction persists and oxygen need is not matched by supply, the microcirculation can be recruited by reducing pathological shunting, promoting microcirculatory perfusion, supporting pump function, and controlling hemorheology and coagulation.
Journal ArticleDOI
How to evaluate the microcirculation: report of a round table conference
Daniel De Backer,Steven M. Hollenberg,Christiaan Boerma,Peter Goedhart,Gustavo Luiz Büchele,Gustavo A. Ospina-Tascón,Iwan Dobbe,Can Ince +7 more
TL;DR: It is proposed that scoring of the microcirculation should include an index of vascular density, assessment of capillary perfusion and a heterogeneity index, which is likely that image analysis software will ease analysis in the future.
Journal ArticleDOI
A Unified Theory of Sepsis-Induced Acute Kidney Injury: Inflammation, microcirculatory dysfunction, bioenergetics and the tubular cell adaptation to injury
Hernando Gomez,Can Ince,Daniel De Backer,Peter Pickkers,Didier Payen,John Hotchkiss,John A. Kellum +6 more
TL;DR: It is proposed that the interplay between inflammation and oxidative stress, microvascular dysfunction, and the adaptive response of the tubular epithelial cell to the septic insult is mostly adaptive in origin, that it is driven by mitochondria, and that it ultimately results in and explains the clinical phenotype of sepsis-induced AKI.
References
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Journal ArticleDOI
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TL;DR: An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae as mentioned in this paper.
Journal ArticleDOI
The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine
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Journal ArticleDOI
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
TL;DR: This study randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit.
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.