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The comparison of stroke volume variation with central venous pressure in predicting fluid responsiveness in septic patients with acute circulatory failure
Conclusions: When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.
Source: Indian Journal of Critical Care Medicine - July 8, 2015 Category: Intensive Care Authors: Santhalakshmi AngappanSatyen ParidaArumugam VasudevanAshok Shankar Badhe Source Type: research

Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. Net fluid balance for the ICU stay was lower in the SV group (1.77L) than in the UC group (5.36L) (p=0.022).
Source: Journal of Critical Care - June 28, 2017 Category: Intensive Care Authors: Heath E. Latham, Charles D. Bengtson, Lewis Satterwhite, Mindy Stites, Dipti P. Subramaniam, G. John Chen, Steven Q. Simpson Source Type: research

Pattern of brain injury in the acute setting of human septic shock
Conclusions: Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality.
Source: Critical Care - September 18, 2013 Category: Intensive Care Authors: Andrea PolitoFrédéric EischwaldAnne-Laure Le MahoAngelo PolitoEric AzabouDjillali AnnaneFabrice ChrétienRobert StevensRobert CarlierTarek Sharshar Source Type: research

Effect of acute endotoxemia on analog estimates of mean systemic pressure
Abstract: Dynamic estimates of mean systemic pressure based on a Guytonian analog model (Pmsa) appear accurate under baseline conditions but may not remain so during septic shock because blood volume distribution and resistances between arterial and venous beds may change. Thus, we examined the effect of acute endotoxemia on the ability of Pmsa, estimated from steady-state cardiac output, right atrial pressure, and mean arterial pressure, to reflect our previously validated instantaneous venous return measure of mean systemic pressure (Pmsi), derived from beat-to-beat measures of right ventricular stroke volume and right a...
Source: Journal of Critical Care - June 3, 2013 Category: Intensive Care Authors: Jae Myeong Lee, Olufunmilayo Ogundele, Francis Pike, Michael R. Pinsky Tags: Electronic Articles Source Type: research

Fluid responsiveness prediction using Vigileo FloTrac measured cardiac output changes during passive leg raise test
ConclusionsCO changes measured by the Vigileo ™ monitor using third-generation software during a PLR test predict fluid responsiveness in mixed medical and surgical patients withvasopressor-dependent circulatory shock.
Source: Journal of Intensive Care - October 5, 2016 Category: Intensive Care Source Type: research

The use of bedside echocardiography for measuring cardiac index and systemic vascular resistance in pediatric patients with septic shock
Conclusion: There was a persistently high systemic vascular resistance index in cold shock patients that influenced the stroke volume index, cardiac index, and velocity time integral. The use of echocardiograms for hemodynamic measurements is important in pediatric septic shock patients to adjust dilators, and vasopressor doses and achieve resuscitation targets in a timely manner.
Source: Revista Brasileira de Terapia Intensiva - January 17, 2019 Category: Intensive Care Source Type: research

Webcast Highlights Third Edition of SSC Guidelines
Severe sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year, killing one in four (and often more), and increasing in incidence. Similar to polytrauma, acute myocardial infarction, or stroke, the speed and appropriateness of therapy administered in the initial hours after severe sepsis develops are likely to influence outcome. During the Society of Critical Care Medicine’s (SCCM) webcast, What's New in the Third Edition of the SSC Guidelines?, R. Phillip Dellinger, MD, MCCM, and Christa A. Schorr, RN, MSN, FCCM, will discuss the additions to the latest update of t...
Source: SCCM RSS News - May 16, 2013 Category: Intensive Care Source Type: news

Ventriculo-arterial decoupling in human septic shock
Conclusions: On admission to ICU patients in septic shock often display significant ventriculo-arterial decoupling that is associated with impaired left ventricular performance. Since Ea/Ees decoupling alters cardiovascular efficiency and cardiac energetic requirements independent of Ea or Ees, we speculate that uncoupled septic patients may benefit from therapy aimed at normalizing Ea/Ees.
Source: Critical Care - April 24, 2014 Category: Intensive Care Authors: Fabio GuarracinoBaldassarre FerroAndrea MorelliPietro BertiniRubia BaldassarriMichael Pinsky Source Type: research

Optimization of preload in severe sepsis and septic shock.
Authors: Shujaat A, Bajwa AA Abstract In sepsis both under- and overresuscitation are associated with increased morbidity and mortality. Moreover, sepsis can be complicated by myocardial dysfunction, and only half of the critically ill patients exhibit preload responsiveness. It is of paramount importance to accurately, safely, and rapidly determine and optimize preload during resuscitation. Traditional methods of determining preload based on measurement of pressure in a heart chamber or volume of a heart chamber ("static" parameters) are inaccurate and should be abandoned in favor of determining preload responsive...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Dynamic arterial elastance predicts mean arterial pressure decrease associated with decreasing norepinephrine dosage in septic shock
IntroductionGradual reduction of the dosage of norepinephrine (NE) in patients with septic shock is usually left to the physician?s discretion. No haemodynamic indicator predictive of the possibility of decreasing the NE dosage is currently available at the bedside. The respiratory pulse pressure variation / respiratory stroke volume variation (dynamic arterial elastance (Eadyn)) ratio has been proposed as an indicator of vascular tone. The purpose of this study was to determine whether Eadyn can be used to predict the decrease in arterial pressure when decreasing the NE dosage in resuscitated septic patients. Methods: A p...
Source: Critical Care - January 19, 2015 Category: Intensive Care Authors: Pierre-Grégoire GuinotEugénie BernardMélanie LevrardHervé DupontEmmanuel Lorne Source Type: research

Effects of fluid administration on arterial load in septic shock patients
Conclusion Fluid administration significantly reduced arterial load in critically patients with septic shock and acute circulatory failure, even when increasing cardiac output. This explains why some septic patients increase their cardiac output after fluid administration without improving blood pressure.
Source: Intensive Care Medicine - June 11, 2015 Category: Intensive Care Source Type: research

Risk of type 2 diabetes mellitus in patients with acute critical illness: a population-based cohort study
Conclusion Our results suggest that patients with certain critical illnesses are associated with a high risk of developing T2DM. Clinicians should be aware of this association and intensively screen for T2DM in patients following diagnosis of critical illness.
Source: Intensive Care Medicine - September 14, 2015 Category: Intensive Care Source Type: research

Changes in B-type natriuretic peptide and related hemodynamic parameters following a fluid challenge in critically ill patients with severe sepsis or septic shock
Conclusions: An increase in BNP soon after a fluid challenge may have some predictive utility of a large LVEDd, which in turn can be used to independently predict the SV response to a fluid challenge.
Source: Indian Journal of Critical Care Medicine - March 8, 2017 Category: Intensive Care Authors: Shahed Omar Ahmad Ali Yahya Atiya Rudo Lufuno Mathivha Joel M Dulhunty Source Type: research

Passive leg raising test with minimally invasive monitoring: the way forward for guiding septic shock resuscitation?
ConclusionsThe passive leg raising maneuver in combination with real-time measurement of cardiac output changes is an easy-to-use, fast, relatively unbiased, and accurate bedside test to guide fluid management during septic shock.
Source: Journal of Intensive Care - June 8, 2017 Category: Intensive Care Source Type: research

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