Association between peripheral perfusion, microcirculation and mortality in sepsis: a systematic review

In conclusion, the diagnosis of hypoperfusion/microcirculatory abnormalities in peripheral non-vital organs was associated with increased mortality. However, additional studies must be undertaken to verify if this association can be considered a marker of the gravity or a trigger factor for organ failure in sepsis.ResumoEmbora evidências crescentes apoiem a monitorização da perfusão periférica em pacientes sépticos, nenhuma revisão sistemática foi realizada para explorar a força da associação entre a má perfusão avaliada na microcirculação dos tecidos periféricos e a mortalidade. Uma busca nas bases de dados mais importantes foi realizada para encontrar artigos publicados até fevereiro de 2018 que correspondessem aos critérios deste estudo, utilizando diferentes palavras-chave: sepse, mortalidade, prognóstico, microcirculação e perfusão periférica. Os critérios de inclusão foram estudos que avaliaram a associação entre perfusão/microcirculação periférica e mortalidade em sepse. Os critérios de exclusão adotados foram os seguintes: artigos de revisão, estudos com animais/pré-clínicos, metanálises, resumos, anais de congressos, editoriais, cartas, relatos de casos, artigos duplicados e artigos que não continham resumo...
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research

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The clinical use of vasoactive drugs aims to improve hemodynamic variables and thereby maintain or restore adequate perfusion and oxygenation in accordance with metabolic demands. A main focus in the management of patients with brain pathology during surgery and neurointensive care is restoring and/or maintaining adequate cerebral perfusion pressure in order to ensure cerebral blood flow in accordance with metabolic demands. One commonly used clinical strategy is the administration of vasoactive drugs aiming to increase mean arterial blood pressure and thereby cerebral perfusion pressure. Here, we first describe the anatom...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Review Articles Source Type: research
AbstractPurpose of reviewEndovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke.Recent findingsThe indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6 –24 h after last-known-well, and improved device and operator proficiency allowi...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Abstract Renal medullary hypoxia may contribute to the pathophysiology of acute kidney injury, including that associated with cardiac surgery requiring cardiopulmonary bypass (CPB). When performed under volatile (isoflurane) anesthesia in sheep, CPB causes renal medullary hypoxia. There is evidence that total intravenous anesthesia (TIVA) may preserve renal perfusion and renal oxygen delivery better than volatile anesthesia. Therefore, we assessed the effects of CPB on renal perfusion and oxygenation in sheep under propofol/fentanyl-based TIVA. Sheep (n = 5) were chronically instrumented for measurement of whole r...
Source: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology - Category: Physiology Authors: Tags: Am J Physiol Regul Integr Comp Physiol Source Type: research
ConclusionsThese results suggest that the impaired CBF autoregulation associated with placental ischemia is due, at least in part, to activation of the AT1 receptor and that the RAS may interact with other placental factors to promote cerebrovascular changes common to preeclampsia.
Source: Biology of Sex Differences - Category: Biology Source Type: research
In an acute endotoxic septic shock sheep model, we studied the effects of esmolol (an ultrashort acting ß1‐selective adrenoceptor antagonist) administration on renal blood flow and the static and dynamic renal autoregulation during acute septic shock. Our data reveal that both the resuscitated endotoxin shock and the β‐blocker infusion left the renal autoregulation parameters unchanged. However, esmolol reduced the perfusion pressure to critical values thereby significantly reducing renal blood flow. AbstractClinical data suggests that heart rate (HR) control with selective β1‐blockers may improve car...
Source: Physiological Reports - Category: Physiology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Handheld vital microscopes allow for direct observation of the sublingual microcirculatory perfusion during cardiac surgery. Through the use of handheld vital microscopes, it has been shown that cardiac surgery with cardiopulmonary bypass is associated with reduced and heterogenous microcirculatory perfusion. Microcirculatory impairment can result in inadequate tissue perfusion, leading to perioperative complications and poor outcome. Because microcirculatory impairment can occur despite stable or improved global hemodynamics, there is a yet unmet need for specific monitoring of the microcirculation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
Introduction - Transcranial Doppler (TCD) plays a crucial role in the INTRA-operative detection of patients at risk for cerebral hyperperfusion (CH) following carotid endarterectomy (CEA) under general anesthesia. However, cerebral perfusion patterns in the POST-operative phase may lead to different cerebral hyperperfusion syndrome (CHS) risk assessment.1 The aim of this study was to determine the diagnostic value of additional postoperative TCD measurements after CEA for the prediction of CH and CHS.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
AbstractPurposeTo investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS).MethodsFrom April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of>70%, or a degree of fixed stenosis>50% in addition to either perfusion impairment or evidence to re-occlusion. Good outcome was defined as mRS ≤2 at 90 days. Both logistic regression and receiver operating characteristic curve (ROC) analyses were performe...
Source: Clinical Neuroradiology - Category: Neurology Source Type: research
Authors: Wang F, Li Y, Cui C, Xue Z, Ma H Abstract Anesthetics have long been proven to have additional effects other than anesthesia on different organs and tissues of the human body. Barrier tissues play critical roles in human health and diseases, yet the impacts of anesthetics on barrier tissues are still not clear. This review article is aimed at summarizing different effects of anesthetics on the skin, the respiratory, and intestinal membranes from two aspects: inflammation/immunity and ischemia-reperfusion. Among volatile, intravenous, and local anesthetics, volatile anesthetics are less influential on barri...
Source: Journal of Immunology Research - Category: Allergy & Immunology Tags: J Immunol Res Source Type: research
ConclusionsShe needed radical resection according to the actual situation. However, her age restricted her tolerance to general anesthesia; relatively conservative treatment options are available to ensure a high quality of life. The treatment of primary tumor resection combined with bladder perfusion chemotherapy is feasible. This case highlights the importance of the dissemination of new cases and optimizing primary urethral cancer diagnosis to obtain an effective treatment.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
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