Patient-Specific Monitoring and Trend Analysis of Model-Based Markers of Fluid Responsiveness in Sepsis: A Proof-of-Concept Animal Study.
Patient-Specific Monitoring and Trend Analysis of Model-Based Markers of Fluid Responsiveness in Sepsis: A Proof-of-Concept Animal Study. Ann Biomed Eng. 2019 Nov 25;: Authors: Murphy L, Davidson S, Chase JG, Knopp JL, Zhou T, Desaive T Abstract Total stressed blood volume ([Formula: see text]) and arterial elastance ([Formula: see text]) are two potentially important, clinically applicable metrics for guiding treatment in patients with altered hemodynamic states. Defined as the total pressure generating blood in the circulation, [Formula: see text] is a potential direct measurement of tissue perfusion, a critical component in treatment of sepsis. [Formula: see text] is closely related to arterial tone thus provides insight into cardiac efficiency. However, it is not clinically feasible or ethical to measure [Formula: see text] in patients, so a three chambered cardiovascular system model using measured left ventricle pressure and volume, aortic pressure and central venous pressure is implemented to identify [Formula: see text] and [Formula: see text] from clinical data. [Formula: see text] and [Formula: see text] are identified from clinical data from six (6) pigs, who have undergone clinical procedures aimed at simulating septic shock and subsequent treatment, to identify clinically relevant changes. A novel, validated trend analysis method is used to adjudge clinically significant changes in state in the real-time [Formula: see text] and [Formula: see...
In this study, gapCO2 induced by hyperventilation significantly increased, while the central venous carbon dioxide pressure (PvCO2) and the partial pressure of CO2 (PaCO2) in arteries decreased. The decreasing trend of the PaCO2 was more obvious than that of the PvCO2. HCO3− and ctCO2 were markedly decreased, when the RR was increased (P
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Jean-Louis Vincent, Glenn Hernandez
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Raúl J. Gazmuri, Cristina Añez de Gomez
Publication date: April 2020Source: Journal of Critical Care, Volume 56Author(s): Daniel De Backer, Jean-Louis Teboul, Bernd Saugel
We support a paradigm shift in the management of septic shock from pressure-guided to perfusion-centered, expected to improve outcome while reducing adverse effects from vasopressor therapy and aggressive fluid resuscitation. We propose focusing the hemodynamic management of septic shock on reversing organ hypoperfusion instead of attaining a predefined MAP target as the key strategy for improving outcome.
Fluid boluses are administered to septic shock patients with the purpose of increasing cardiac output as a means to restore tissue perfusion. Unfortunately, fluid therapy has a narrow therapeutic index, and th...
ConclusionsWe propose focusing the hemodynamic management of septic shock on reversing organ hypoperfusion instead of attaining a predefined MAP target as the key strategy for improving outcome.
β-adrenoceptor antagonist (β-blocker) may have potential in the treatment of septic shock and sepsis. However, the relevant research findings are still controversial. β-blocker of esmolol is safe and effective in improving 28-day mortality and controlling ventricular rate in patients with sepsis after fluid resuscitation, and has no significant adverse effect on tissue perfusion.
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...