Bedside determination of microcirculatory oxygen delivery and uptake: a prospective observational clinical study for proof of principle

AbstractAssessment of microcirculatory functional capacity is considered to be of prime importance for therapy guidance and outcome prediction in critically ill intensive care patients. Here, we show determination of skin microcirculatory oxygen delivery and consumption rates to be a feasible approach at the patient’s bedside. Real time laser-doppler flowmetry (LDF) and white light spectrophotometry (WLS) were used for assessment of thenar skin microperfusion, regional Hb and postcapillary venous oxygen saturation before and after forearm ischemia. Adapted Fick’s principle equations allowed for calculation of microcirculatory oxygen delivery and uptake. Patient groups with expected different microcirculatory status were compared [control (n = 20), sepsis-1/2 definition criteria identified SIRS (n = 10) and septic shock patients (n = 20), and the latter group further classified according to sepsis-3 definition criteria in sepsis (n = 10) and septic shock (n = 10)], respectively. In otherwise healthy controls, microcirculatory oxygen delivery and uptake approximately doubled after ischemia with maximum values (mDO2max and mVO2max) significantly lower in SIRS or septic patient groups, respectively. Scatter plots of mVO2max and mDO2max values defined a region of unphysiological low values not observed in control but in critically ill patients with the percentage of dots within this region being highest in septic shock patients. LDF and WLS combined with vasoocclusive testing reveals significant differences in microcirculatory oxygen delivery and uptake capacity between control and critically ill patients. As a clinically feasible technique for bedside determination of microcirculatory oxygen delivery and uptake, LDF and WLS combined with vasoocclusive testing holds promise for monitoring of disease progression and/or guidance of therapy at the microcirculatory level to be tested in further clinical trials.ClinicalTrials.gov: NCT01530932.

Download Full-text

Thenar Oxygen Saturation and Invasive Oxygen Delivery Measurements in Critically Ill Patients in Early Septic Shock

Shock ◽

10.1097/shk.0b013e3182094ab9 ◽

2011 ◽

Vol 35 (5) ◽

pp. 456-459 ◽

Cited By ~ 15

Author(s):

Jaume Mesquida ◽

Guillem Gruartmoner ◽

Maria Luisa Martínez ◽

Jordi Masip ◽

Caroline Sabatier ◽

...

Keyword(s):

Septic Shock ◽

Oxygen Saturation ◽

Critically Ill ◽

Critically Ill Patients ◽

Oxygen Delivery

Download Full-text

Faculty Opinions recommendation of Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718312921.793493679 ◽

2014 ◽

Author(s):

Niranjan Kissoon ◽

Srinivas Murthy

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

New Zealand ◽

Critically Ill ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

Download Full-text

The Effect of Nutrition on Early Stress-Induced Hyperglycemia, Serum Insulin Levels, and Exogenous Insulin Administration in Critically Ill Patients With Septic Shock

Shock ◽

10.1097/shk.0000000000001287 ◽

2019 ◽

Vol 52 (4) ◽

pp. e31-e38 ◽

Cited By ~ 1

Author(s):

Nikki Treskes ◽

Wilhelmina Aria Christina Koekkoek ◽

Arthur Raymond Hubert van Zanten

Keyword(s):

Septic Shock ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Insulin ◽

Exogenous Insulin ◽

Insulin Administration ◽

Insulin Levels ◽

Early Stress

Download Full-text

Evaluation of Dexmedetomidine Dosing in Obese Critically Ill Patients

Journal of Pharmacy Practice ◽

10.1177/08971900211021578 ◽

2021 ◽

pp. 089719002110215

Author(s):

Sara A. Atyia ◽

Keaton S. Smetana ◽

Minh C. Tong ◽

Molly J. Thompson ◽

Kari M. Cape ◽

...

Keyword(s):

Body Weight ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Difference ◽

Ideal Body Weight ◽

Weight Percentage ◽

Before And After ◽

Light Sedation ◽

Icu Sedation ◽

Dose Dependent

Background: Dexmedetomidine is a highly selective α2-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Due to these ideal sedative properties, there has been increased interest in utilizing dexmedetomidine as a first-line sedative for critically ill patients requiring light sedation. Objective: To evaluate the ability to achieve goal intensive care unit (ICU) sedation before and after an institutional change of dosing from actual (ABW) to adjusted (AdjBW) body weight in obese patients on dexmedetomidine. Methods: This study included patients ≥ 18 years old, admitted to a surgical or medical ICU, required dexmedetomidine for at least 8 hours as a single continuous infusion sedative, and weighed ≥ 120% of ideal body weight. Percentage of RASS measurements within goal range (−1 to +1) during the first 48 hours after initiation of dexmedetomidine as the sole sedative agent or until discontinuation dosed on ABW compared to AdjBW was evaluated. Results: 100 patients were included in the ABW cohort and 100 in the AdjBW cohort. The median dosing weight was significantly higher in the ABW group (95.9 [78.9-119.5] vs 82.2 [72.1-89.8] kg; p = 0.001). There was no statistical difference in percent of RASS measurements in goal range (61.5% vs 69.6%, p = 0.267) in patients that received dexmedetomidine dosed based on ABW versus AdjBW. Conclusion: Dosing dexmedetomidine using AdjBW in obese critically ill patients for ongoing ICU sedation resulted in no statistical difference in the percent of RASS measurements within goal when compared to ABW dosing. Further studies are warranted.

Download Full-text

Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽

10.3390/antibiotics10010076 ◽

2021 ◽

Vol 10 (1) ◽

pp. 76

Author(s):

Matthaios Papadimitriou-Olivgeris ◽

Christina Bartzavali ◽

Alexandra Georgakopoulou ◽

Fevronia Kolonitsiou ◽

Chrisavgi Papamichail ◽

...

Keyword(s):

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

Bloodstream Infections ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Carbapenemase Gene ◽

Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

Download Full-text

Glucocorticoid Sensitivity Is Highly Variable in Critically Ill Patients With Septic Shock and Is Associated With Disease Severity*

Critical Care Medicine ◽

10.1097/ccm.0000000000001633 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1034-1041 ◽

Cited By ~ 18

Author(s):

Jeremy Cohen ◽

Carel J. Pretorius ◽

Jacobus P. J. Ungerer ◽

John Cardinal ◽

Antje Blumenthal ◽

...

Keyword(s):

Septic Shock ◽

Disease Severity ◽

Critically Ill ◽

Critically Ill Patients ◽

Glucocorticoid Sensitivity

Download Full-text

Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

JAMA ◽

10.1001/jama.2011.697 ◽

2011 ◽

Vol 305 (21) ◽

pp. 2175 ◽

Cited By ~ 285

Author(s):

Craig M. Lilly

Keyword(s):

Critical Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Care Processes ◽

Before And After

Download Full-text

Evaluation of bedbath in critically ill patients: impact of water temperature on the pulse oximetry variation

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-62342010000400026 ◽

2010 ◽

Vol 44 (4) ◽

pp. 1039-1045 ◽

Cited By ~ 1

Author(s):

Aretha Pereira de Oliveira ◽

Dalmo Valério Machado de Lima

Keyword(s):

Water Temperature ◽

Critically Ill ◽

Critically Ill Patients ◽

Age Groups ◽

University Hospital ◽

Convenience Sample ◽

Level Ii ◽

Before And After ◽

Quasi Experimental ◽

Water Temperature Data

This is a participant study, quasi-experimental, of a before and after type. A quantitative approach of biophysiological measures was used, represented by the saturation of oxygen measured by pulse oximeter (SpO2), and recorded on three occasions: before, during and after the bedbath in critically ill patients hospitalized at the ICU of a University Hospital in Brazil. Objective: to compare the SpO2 in various stages of the bath, with and without control of water temperature. Data collection was performed between December 2007 and April 2008 on a convenience sample consisting of 30 patients aged over 18 who had classification in TISS-28 from level II. Results show that water temperature control means a lower variation of SpO2 (p<0.05). No marked differences in variation of saturation between men and women or between age groups were established. In conclusion, heated and constant water temperature during the bedbath is able to minimize the fall of SpO2 that occurs while handling patients during procedures.

Download Full-text