Hemodynamic and Perfusion End Points for Volemic Resuscitation in Sepsis

Ramos, Fernando José da Silva; Azevedo, Luciano César Pontes

doi:10.1097/shk.0b013e3181e7e642

Cited by 37 publications

(17 citation statements)

References 50 publications

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“…Current management of septic shock includes early identification andtreatmentof the causative infection [66–68], adequate and rapid hemodynamic resuscitation [52, 69, 70], treatment of organ failure, corticosteroids [71], and modulation of the immune response [72, 73]. There are many comprehensive reviews on these topics and hence we will only review those strategies related to complements.…”

Section: Complement-related Therapeutic Strategies For Septic Shockmentioning

confidence: 99%

The Role of Complement System in Septic Shock

Charchaflieh

Wei

Labaze

et al. 2012

Clinical and Developmental Immunology

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Septic shock is a critical clinical condition with a high mortality rate. A better understanding of the underlying mechanisms is important to develop effective therapies. Basic and clinical studies suggest that activation of complements in the common cascade, for example, complement component 3 (C3) and C5, is involved in the development of septic shock. The involvement of three upstream complement pathways in septic shock is more complicated. Both the classical and alternative pathways appear to be activated in septic shock, but the alternative pathway may be activated earlier than the classical pathway. Activation of these two pathways is essential to clear endotoxin. Recent investigations have shed light on the role of lectin complement pathway in septic shock. Published reports suggest a protective role of mannose-binding lectin (MBL) against sepsis. Our preliminary study of MBL-associated serine protease-2 (MASP-2) in septic shock patients indicated that acute decrease of MASP-2 in the early phase of septic shock might correlate with in-hospital mortality. It is unknown whether excessive activation of these three upstream complement pathways may contribute to the detrimental effects in septic shock. This paper also discusses additional complement-related pathogenic mechanisms and intervention strategies for septic shock.

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Section: Complement-related Therapeutic Strategies For Septic Shockmentioning

confidence: 99%

The Role of Complement System in Septic Shock

Charchaflieh

Wei

Labaze

et al. 2012

Clinical and Developmental Immunology

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“…The ultimate goal of hemodynamic support is to provide enough oxygen delivery (DO 2 ) to guarantee tissue oxygen needs and avoid organ dysfunction (1,2). Under normal conditions, DO 2 exceeds oxygen consumption (VO 2 ) to an extent that makes consumption independent of delivery (3,4).…”

Section: Introductionmentioning

confidence: 99%

Effects of arterial oxygen tension and cardiac output on venous saturation: a mathematical modeling approach

Zampieri¹,

Park²,

Azevedo³

et al. 2012

Clinics

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OBJECTIVES:Hemodynamic support is aimed at providing adequate O2 delivery to the tissues; most interventions target O2 delivery increase. Mixed venous O2 saturation is a frequently used parameter to evaluate the adequacy of O2 delivery.METHODS:We describe a mathematical model to compare the effects of increasing O2 delivery on venous oxygen saturation through increases in the inspired O2 fraction versus increases in cardiac output. The model was created based on the lungs, which were divided into shunted and non-shunted areas, and on seven peripheral compartments, each with normal values of perfusion, optimal oxygen consumption, and critical O2 extraction rate. O2 delivery was increased by changing the inspired fraction of oxygen from 0.21 to 1.0 in steps of 0.1 under conditions of low (2.0 L.min-1) or normal (6.5 L.min-1) cardiac output. The same O2 delivery values were also obtained by maintaining a fixed O2 inspired fraction value of 0.21 while changing cardiac output.RESULTS:Venous oxygen saturation was higher when produced through increases in inspired O2 fraction versus increases in cardiac output, even at the same O2 delivery and consumption values. Specifically, at high inspired O2 fractions, the measured O2 saturation values failed to detect conditions of low oxygen supply.CONCLUSIONS:The mode of O2 delivery optimization, specifically increases in the fraction of inspired oxygen versus increases in cardiac output, can compromise the capability of the “venous O2 saturation” parameter to measure the adequacy of oxygen supply. Consequently, venous saturation at high inspired O2 fractions should be interpreted with caution.

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“…Fonte: Rabello et al (2009) e Levy et al (2003) Posteriormente ao estadiamento do paciente, havendo a necessidade da realização da ressuscitação volêmica hemodinâmica, primeiramente deve-se realizar um exame físico minucioso, com a solicitação de exames laboratoriais que avaliem a função metabólica e orgânica, além da aferição dos valores do lactato sérico, saturação de oxigênio central ou venosa mista e déficit de base. Valores estes, que avaliam de forma efetiva a perfusão, oxigenação e metabolismo tecidual, beneficiando na escolha da terapêutica clínica mais eficiente para o quadro clínico (SILVA ; AZEVEDO, 2010). Quando há um déficit no volume intravascular em virtude da vasodilatação e aumento da permeabilidade microvascular originada da sepse, o quadro de hipovolemia orgânica pode ser observado, podendo evoluir muitas vezes para a falência múltipla dos órgãos (BALUNA ; VITETTA, 1997).…”

Section: Organ Dysfunctionunclassified

“…Indícios estes de coagulação intravascular disseminada (CID). O aumento nos valores do lactato sérico pode ser considerado uma alteração multifatorial, resultante da diminuição acentuada da perfusão tecidual, levando a inibição da piruvato desidrogenase (PDH) e redução na depuração do lactato pelas células hepáticas (PAIXÃO, 2005;AZEVEDO, 2010;RABELO, 2012).…”

Section: Sinais Clínicos E Diagnósticos Da Sepse Graveunclassified

Reposição Volêmica em cães portadores de sepse grave: Revisão de Literatura

et al. 2013

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RESUMO:A água por ser um componente vital para todas as formas de vida torna-se uma ferramenta importante na terapia de várias afecções. A utilização da reposição volêmica visa restabelecer as perdas hidroeletrolíticas e a homeostase do organismo. Quando pacientes apresentam-se no quadro de sepse grave, uma síndrome complexa de caráter emergencial há a presença da instabilidade hemodinâmica levando ao quadro de hipoperfusão e hipóxia tecidual, podendo evoluir para a disfunção múltipla de órgãos. Contudo, um exame físico minucioso associado ao diagnóstico precoce e a realização da terapia de reposição volêmica, podem reduzir a alta taxa de mortalidade destes pacientes, sendo este um desafio para o médico veterinário. Com isso, buscou-se realizar uma atualização bibliográfica, destacando as principais definições, classificações, fisiopatogenia, sinais clínicos e causas de sepse grave, enfatizando a necessidade de terapia e protocolos de reposição volêmica neste contexto, bem como a importância do monitoramento clínico dos pacientes.Palavras-chave: Sepse. Volemia. Fluidoterapia. Cães. SUMMARY:The water to be a vital component in all forms of life becomes an important tool in the therapy of various disorders. The use of volume replacement aims to restore losses and electrolyte homeostasis. When patients are under severe sepsis, a syndrome of emergency, there is the presence of hemodynamic instability leading to the picture of hypoperfusion and tissue hypoxia, which may progress to multiple organ dysfunction. However, a thorough physical examination associated with early diagnosis and the realization of fluid replacement therapy, may reduce the high mortality rate of these patients, which is a challenge for the veterinarian. Therefore, we attempted to perform an updated, highlighting key definitions, classifications, pathophysiology, clinical signs and causes of severe sepsis, emphasizing the need for therapy and fluid resuscitation protocols in this context, as well as the importance of monitoring patients' clinical. Keywords:Sepsis. Blood volume. Fluid therapy. Dogs . INTRODUÇÃOA água é um componente fundamental para a homeostase orgânica, na qual estão disseminadas substâncias coloidais de grande complexidade (HOUPT, 1996). Para a manutenção e controle de sua composição, são necessários que os líquidos corporais banhem as células e os tecidos, auxiliando no desempenho de funções específicas como oxigenação e nutrição hidroeletrolítica celular HALL, 2002). A fluidoterapia, um procedimento clínico utilizado na rotina médica veterinária, tem por objetivo restaurar o volume, composição e a manutenção dos fluidos corporais, de modo que o ganho se iguale às perdas. Atualmente, há uma grande variedade de fluidos à disposição dos clínicos, como também suas recomendações necessárias, indicações, dosagem, velocidade de infusão e vias de administrações mais adequadas (SENIOR, 1997).

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Hemodynamic and Perfusion End Points for Volemic Resuscitation in Sepsis

Cited by 37 publications

References 50 publications

The Role of Complement System in Septic Shock

The Role of Complement System in Septic Shock

Effects of arterial oxygen tension and cardiac output on venous saturation: a mathematical modeling approach

Reposição Volêmica em cães portadores de sepse grave: Revisão de Literatura

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