The heart in sepsis: from basic mechanisms to clinical management.

The heart in sepsis: from basic mechanisms to clinical management. Curr Vasc Pharmacol. 2013 Mar 1;11(2):187-95 Authors: Rudiger A, Singer M Abstract Septic shock is characterized by circulatory compromise, microcirculatory alterations and mitochondrial damage, which all reduce cellular energy production. In order to reduce the risk of major cell death and a diminished likelihood of recovery, adaptive changes appear to be activated. As a result, cells and organs may survive in a non-functioning hibernation-like condition. Sepsis-induced cardiac dysfunction may represent an example of such functional shutdown. Sepsis-induced myocardial dysfunction is common, corresponds to the severity of sepsis, and is reversible in survivors. Its mechanisms include the attenuation of the adrenergic response at the cardiomyocyte level, alterations of intracellular calcium trafficking and blunted calcium sensitivity of contractile proteins. All these changes are mediated by cytokines. Treatment includes preload optimization with sufficient fluids. However, excessive volume loading is harmful. The first line vasopressor recommended at present is norepinephrine, while vasopressin can be started as a salvage therapy for those not responding to catecholamines. During early sepsis, cardiac output can be increased by dobutamine. While early administration of catecholamines might be necessary to restore adequate organ perfusion, prolonged administration might be harmful. Novel therap...
Source: Current Vascular Pharmacology - Category: Drugs & Pharmacology Authors: Tags: Curr Vasc Pharmacol Source Type: research

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Condition:   Septic Shock Interventions:   Procedure: Fluid resuscitation and furosemide administration (bolus and continuous) with central venous pressure target 8 - 10 mmHg;   Procedure: Fluid deresuscitation and furosemide administration (bolus and continuous) with central venous pressure target 0 - 4 mmHg Sponsor:   Indonesia University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
The objective of this literature review is to present the theoretical and practical aspects of extracorporeal membrane oxygenation support for respiratory and/or cardiac functions in critically ill patients.
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
CONCLUSIONS: Peripheral perfusion-targeted resuscitation may result in lower mortality and faster resolution of organ dysfunction when compared to a lactated-targeted resuscitation strategy. This reanalysis can aid clinicians interpret the results of the trial. PMID: 31574228 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research
In patients with septic shock, the skin is often chosen for the evaluation of peripheral perfusion and oxygenation. Changes in skin microcirculatory vessel oxygen saturation and relative hemoglobin concentrati...
Source: Critical Care - Category: Intensive Care Authors: Tags: Research Source Type: research
The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO2 reveal a consistent relationship between these two biomarkers.MethodsA retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO2 or mixed venous oxygen saturation (SvO2) measurement made +/ − 1 h from the lactate were included. Linear and non-linear correlations of ScvO2 and lactate were assessed in a variety of shock states.ResultsTwo thousand sixty-two patients were included....
Source: Journal of Intensive Care - Category: Intensive Care Source Type: research
Heterogeneity of microvascular blood flow leading to tissue hypoxia is a common finding in patients with septic shock. It may be related to suboptimal systemic perfusion pressure and lead to organ failure. Map...
Source: Annals of Intensive Care - Category: Intensive Care Authors: Tags: Research Source Type: research
A peripheral perfusion-targeted resuscitation during early septic shock has shown encouraging results. Capillary refill time, which has a prognostic value, was used. Adding accuracy and predictability on capil...
Source: Critical Care - Category: Intensive Care Authors: Tags: Research Source Type: research
Authors: Yuan S, He H, Long Y Abstract The venous-to-arterial carbon dioxide difference [P(v-a)CO2] was calculated from the difference of venous CO2 and arterial CO2, which has been used to reflect the global flow in the circulatory shock. Moreover, recent clinical studies found the P(v-a)CO2 was related to the sublingual microcirculation perfusion in the sepsis. However, it is still controversial that whether P(v-a)CO2 could be used to assess the microcirculatory flow in septic patients. Moreover, the related influent factors should be taken into account when interpreting P(v-a)CO2 in clinical practice. This paper...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
It is unknown whether the recommended mean arterial pressure (MAP) target of 65 mmHg during initial resuscitation of septic shock is sufficient to maintain cerebral perfusion. Thus, we tested the hypothesis that a higher MAP target in patients with septic shock may improve level of arousal. In patients with septic shock who were mechanically ventilated and sedated, resuscitation with MAP target between 80 and 85 mmHg was associated with higher arousal level as compared to a MAP target between 65 and 70 mmHg.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
Along with heart rate, the arterial blood pressure is the most commonly used variable to assess the cardiovascular status in the general population. Physicians caring patients with chronic hypertension are well aware of the necessity to target a very tight safe range of diastolic arterial pressure (DAP), when using anti-hypertensive drugs. We believe that the DAP as a marker of arterial tone and as the upstream pressure for the left ventricular perfusion, is as an important variable to be considered in patients with septic shock. Since the DAP is easily obtained in such patients using an arterial catheter, it would be regr...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
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