Faculty Opinions recommendation of Hemodynamic variables related to outcome in septic shock.

2006 ◽  
Author(s):  
Martin Duenser
Keyword(s):  
Septic Shock ◽  
Hemodynamic Variables

scholarly journals Unfractionated Heparin Improves the Intestinal Microcirculation in a Canine Septic Shock Model

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Heng Zhang ◽  
Yini Sun ◽  
Xin An ◽  
Xiaochun Ma
Keyword(s):  
Septic Shock ◽  
Unfractionated Heparin ◽  
Flow Index ◽  
Shock Model ◽  
Microcirculatory Perfusion ◽  
Basic Therapy ◽  
E Coli ◽  
Intestinal Microcirculation ◽  
Hemodynamic Variables ◽  
Lactate Levels

Background. Alterations of microcirculation are associated with organ hypoperfusion and high mortality in septic shock. This study is aimed at investigating the effects of unfractionated heparin (UFH) on intestinal microcirculatory perfusion and systemic circulation in a septic shock model. Methods. Twenty-four beagle dogs were randomly allocated into four groups: (a) sham group: healthy controls, (b) shock group: septic shock induced by Escherichia coli, (c) basic therapy group: septic shock animals treated with antibiotics and 10 ml/kg/h saline, and (d) heparin group: septic shock animals treated with basic therapy plus UFH. Hemodynamic variables were measured within 24 h after E. coli administration. The intestinal microcirculation was simultaneously investigated with a sidestream dark-field imaging technique. Additionally, the function of vital organs was evaluated at 12 h postadministration (T12). Results. E. coli induced a progressive septic shock in which the mean arterial pressure (MAP) decreased and lactate levels sharply increased, accompanied by deteriorated microvessel perfusion. While basic therapy partially improved the microvascular flow index and the perfused microvessel density in the jejunal villi, UFH significantly restored major microcirculation variables at T12. Physiological variables, including MAP, urine output, and lactate levels, were improved by UFH, whereas some hemodynamic indices were not affected by UFH. With respect to organ function, UFH increased the platelet count and decreased the creatinine level. Conclusions. UFH improves microcirculatory perfusion of the small intestine independently of the changes in systemic hemodynamic variables in a canine model of septic shock, thereby improving coagulation and renal function.

Update on Vasopressors and Inotropes in Septic Shock

2002 ◽  
Vol 15 (2) ◽  
pp. 124-134 ◽  
Author(s):  
Maria I. Rudis ◽  
Clarence Chant
Keyword(s):  
Septic Shock ◽  
Oxygen Transport ◽  
Young Patients ◽  
Tissue Perfusion ◽  
Splanchnic Circulation ◽  
Oxygen Extraction Ratio ◽  
Goal Directed Therapy ◽  
Hemodynamic Variables ◽  
Refractory Hypotension ◽  
Splanchnic Oxygen

Vasopressors and inotropes are used in septic shock in patients who remain hypotensive despite adequate fluid resuscitation. The goal is to increase blood pressure to optimize perfusion to organs. Generally, goal-directed therapy to supra-normal oxygen transport variables cannot be recommended due to lack of benefit. Traditionally, vasopressors and inotropes in septic shock have been started in a step-wise fashion starting with dopamine. Recent data suggest that there may be true differences among vasopressors and inotropes on local tissue perfusion as measured by regional hemodynamic and oxygen transport. When started early in septic shock, norepinephrine decreases mortality, optimizes hemodynamic variables, and improves systemic and regional (eg, renal, gastric mucosal, splanchnic) perfusion. Epinephrine causes a greater increase in cardiac index (CI) and oxygen delivery (DO2 ) and increases gastric mucosal flow, but increases lactic acid and may not adequately preserve splanchnic circulation owing to its predominant vasoconstrictive alpha (α ) effects. Epinephrine may be particularly useful when used earlier in the course of septic shock in young patients and those who do not have any known cardiac abnormalities. Unlike epinephrine, dopamine does not preferentially increase the proportion of CI that preferentially goes to the splanchnic circulation. Dopamine is further limited because it cannot increase CI by more than 35% and is accompanied by tachycardia or tachydysrhythmias. Dopamine, as opposed to norepinephrine, may worsen splanchnic oxygen consumption (VO2 ) and oxygen extraction ratio (O2 ER). Low-dose dopamine has not been shown to consistently increase the glomerular filtration rate or prevent renal failure, and, indeed, worsens splanchnic tissue oxygen use. Routine use of concurrently administered dopamine with vasopressors is not recommended. Phenylephrine should be used when a pure vasoconstrictor is desired in patients who may not require or do not tolerate the beta (β ) effects of dopamine or norepinephrine with or without dobutamine. Patients with high filling pressure and hypotension may benefit from the combination of phenylephrine and dobutamine. Investigational approaches to vasopressor-refractory hypotension in septic shock include the use of vasopressin and corticosteroids.

scholarly journals Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Marta Carrara ◽  
Giuseppe Baselli ◽  
Manuela Ferrario
Keyword(s):  
Septic Shock ◽  
Clinical Information ◽  
Mortality Prediction ◽  
Shock Onset ◽  
The Public ◽  
Hemodynamic Variables ◽  
Mortality Prediction Model ◽  
Critical Care Management ◽  
Recorded Data ◽  
Preliminary Study

We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients.

Hemodynamic variables related to outcome in septic shock

2005 ◽  
Vol 31 (8) ◽  
pp. 1066-1071 ◽  
Author(s):  
Marjut Varpula ◽  
Minna Tallgren ◽  
Katri Saukkonen ◽  
Liisa-Maria Voipio-Pulkki ◽  
Ville Pettilä
Keyword(s):  
Septic Shock ◽  
Hemodynamic Variables

scholarly journals Timing Assessment of Response to Fluid Challenge in Patients with Septic Shock

2021 ◽  
Author(s):  
Hui-bin Huang ◽  
Biao Xu ◽  
Guang-Yun Liu ◽  
Bin Du
Keyword(s):  
Septic Shock ◽  
Repeated Measures ◽  
Time Course ◽  
Fluid Challenge ◽  
Time Points ◽  
Initial Resuscitation ◽  
Hemodynamic Variables ◽  
Assessment Time ◽  
Recorded Data ◽  
Time Courses

Abstract Objectives: Fluid challenge (FC) is most commonly used for fluid responsiveness (FR) evaluation, with a wide divergence in assessment time choices. Therefore, we aimed to explore the optimal assessment time for FC in patients with septic shock. Methods: A prospective cohort study was conducted. Septic shock patients who had experienced initial resuscitation and required an FC with 500 mL 4% gelatin or normal saline (NS) over 5-10 min were included. FR was defined by an increase in cardiac index (CI) >10%. FR and other predefined variables were recorded at baseline (Tb), immediately (T0), and at 10 (T1), 30 (T2), 45 (T3), 60 (T4), 90 (T5), and 120 (T6) min after FC. The incidence of FR and hemodynamic variables at predefined time points were recorded. Data were analyzed by repeated measures of analysis of variance. Results: 63 patients were enrolled, with 43 in the gelatin group and 20 in the NS group. Among the 45/63 (71%) responders, 31 were responded at T0 (ER), while 14 responded at T1 or later (LR). The proportion of NR, ER and LR was comparable between gelatin and NS groups. After FC, the time course of FR status was slightly different between gelatin and NS groups. In the gelatin group, FC induced most responders (69%, 31/45) and frequency of CI maximum (35%, 11/31) at T2 and sustained a positive FR status until T4; while in the NS group, FC induced most responders (55%, 11/20) and frequency of CI maximum (64%, 9/14) at T1, and sustained FR status until T1. Conclusions: Different time courses of FR were found between gelatin and NS group patients undergoing FC. Thus, when NS is used, FR should be performed within 10 min, while it is better to extend the assessment time to 30 min after FC when gelatin is used.

scholarly journals Oxygen Tissue Saturation Is Lower in Nonsurvivors than in Survivors after Early Resuscitation of Septic Shock

2009 ◽  
Vol 111 (2) ◽  
pp. 366-371 ◽  
Author(s):  
Marc Leone ◽  
Sami Blidi ◽  
François Antonini ◽  
Bertrand Meyssignac ◽  
Sébastien Bordon ◽  
...  
Keyword(s):  
Septic Shock ◽  
Oxygen Saturation ◽  
Tissue Oxygenation ◽  
Microvascular Dysfunction ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Hemodynamic Variables ◽  
Central Venous Saturation

Background Growing evidence suggests that the microvascular dysfunction is the key element of the pathogenesis of septic shock. This study's purpose was to explore whether the outcome of septic shock patients after early resuscitation using early goal-directed therapy is related to their muscle tissue oxygenation. Methods Tissue oxygen saturation (Sto2) was monitored in septic shock patients using a tissue spectrometer (InSpectra Model 325; Hutchinson Technology, Hutchinson, MN). For the purpose of this retrospective study, the Sto2 values were collected at the first measurement done after the macrohemodynamic variables (mean arterial pressure, urine output, central venous saturation in oxygen) were optimized. Results After the hemodynamic variables were corrected, no difference was observed between the nonsurvivors and survivors, with the exception of pulse oximetry saturation (94% [92-97%] vs. 97% [94-99%], P = 0.04). The Sto2 values were significantly lower in the nonsurvivors than in the survivors (73% [68-82%] vs. 84% [81-90%], P = 0.02). No correlations were found between the Sto2 and Spo2 (P = 0.7). Conclusions In septic shock patients, tissue oxygen saturation below 78% is associated with increased mortality at day 28. Further investigations are required to determine whether the correction of an impaired level of tissue oxygen saturation may improve the outcome of these patients.

Low-Dose Steroids Cut Mortality in Septic Shock

2006 ◽  
Vol 36 (19) ◽  
pp. 24
Author(s):  
BRUCE JANCIN
Keyword(s):  
Septic Shock ◽  
Low Dose

Septic shock patient and ultrasound in the emergency room

2016 ◽  
Vol 37 (S 01) ◽  
Author(s):  
M Algaba Montes ◽  
AÁ Oviedo García ◽  
M Patricio Bordomás
Keyword(s):  
Septic Shock ◽  
Emergency Room ◽  
Septic Shock Patient
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