Markers of tissue hypoperfusion  in pediatric septic shock

Dugas, M; Proulx, François; Jaeger, Annik de; Lacroix, Jacques; Lambert, Marie

doi:10.1007/s001340050015

Cited by 44 publications

(20 citation statements)

References 27 publications

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“…In severe malaria blood lactate concentrations correlate positively with lactate/pyruvate ratios and lactate/pyruvate ratios are about 30 [7, 14] (compared to a normal value of around 10), implying severe cellular hypoxia. In sepsis reported lactate/pyruvate ratios are lower than those found in malaria (in the range of 15 to 20) [40][41][42][43][44].…”

Section: Equationcontrasting

confidence: 48%

Severe Malaria: Metabolic Complications

Planche¹,

Krishna²

2006

CMM

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Metabolic complications of severe malaria are some of the most important and potentially treatable manifestations of this deadly disease. The commonest metabolic complications (lactic acidosis and hypoglycaemia) arise from increased host anaerobic metabolism probably due to a mismatch between tissue oxygen supply and requirement. Optimising treatments for these complications should be guided by detailed understanding of their underlying pathophysiology, and may help to reduce the intolerably high case fatality rate of severe malaria.

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Section: Equationcontrasting

confidence: 48%

Severe Malaria: Metabolic Complications

Planche¹,

Krishna²

2006

CMM

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“…The predictive value of a single initial lactate level alone may be less useful for risk stratification than the lactate area score, whereas serial lactate measurements may provide important information regarding the effectiveness of resuscitation. Furthermore, the normalization of blood lactate levels is temporally associated with patient recovery during septic shock [29]. Lactate clearance values effectively reflect dynamic changes in lactate levels in patients with severe sepsis but do not provide information regarding the severity of hyperlactatemia.…”

Section: Discussionmentioning

confidence: 98%

Combination of Acute Physiology and Chronic Health Evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock

Wang

Yin

et al. 2015

Journal of Critical Care

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“…24 The most studied marker for severity of septic shock is arterial lactate. 27,28 Normalization of lactate and base defi cit has been associated with recovery from septic shock. 27 Noninvasive monitoring systems for impaired perfusion and shock include gastric tonometry and capnometry.…”

Section: Septic Shockmentioning

confidence: 99%

“…27,28 Normalization of lactate and base defi cit has been associated with recovery from septic shock. 27 Noninvasive monitoring systems for impaired perfusion and shock include gastric tonometry and capnometry. In gastric tonometry, mucosal pH and partial pressure of carbon dioxide (Pco 2 ) are measured to identify splanchnic vasoconstriction, which occurs early in hypoperfused states.…”

Section: Septic Shockmentioning

confidence: 99%

Circulatory Emergencies: Shock

Cho¹,

Rothrock²

2008

Pediatric Emergency Medicine

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Shock is an abnormal physiologic state of inadequate tissue perfusion that is a common end point for various diseases.Physiologic subtypes of shock include hypovolemic, cardiogenic, distributive, and obstructive shock. Multiple subtypes of shock can be present with a single disease.With the exception of cardiogenic shock, the most common mistake in management is not administering enough fl uids in a timely fashion.Use of goal-directed therapy for fl uid-refractory septic shock improves outcome.with only minimal changes in vital signs. 4,5 The term compensated shock is used for patients with shock physiology, but preservation of normal blood pressure. Decompensated shock is used when the patient has hypotension, and is usually a late sign of shock. If untreated, decompensated shock will become irreversible, leading to eventual death.Physiologic subtypes of shock include hypovolemic, cardiogenic, distributive, and obstructive shock. Hypovolemic shock is due to a defi ciency in intravascular volume either through insuffi cient intake or excessive loss of fl uid. Cardiogenic shock is due to failure of the heart to provide suffi cient cardiac output. Distributive shock is defi ned as a change in vascular capacitance resulting in peripheral vasodilation and abnormal redistribution of blood fl ow. Obstructive shock is due to an obstruction of outfl ow from the heart. The differential diagnosis for each type of shock is extensive (Table 8-1).While it is useful to distinguish between the physiologic subtypes of shock, recognition and treatment of the specifi c disorders that lead to shock is equally important. In addition, some diseases have multisystem involvement with several different subtypes of shock. For example, children with septic shock may be hypovolemic from fl uid loss and inadequate intake, and may have sepsis-induced myocardial depression that directly limits contractility and cardiac output. Recognition and ApproachKnowledge of physiologic compensatory responses can help clinicians identify shock subtypes and initiate appropriate management. Cardiac output is regulated by both the heart rate and the stroke volume of each contraction. Preload, cardiac contractility, and afterload determine stroke volume. Preload refl ects both the absolute intravascular volume and changes in venous capacitance. Afterload is related to systemic vascular resistance. The primary physiologic response to compensate for shock is via the sympathetic nervous system. Baroreceptors in the carotid sinus and chemoreceptors in the aorta and carotid bodies sense hypovolemia and hypoxemia, respectively, and activate the sympathetic adrenergic response. The release of catecholamines activates α 1 receptors in peripheral vascular smooth muscle, causing peripheral vasoconstriction. 6 Presynaptic α 2 receptors in the heart and vasculature are activated by norepinephrine released from sympathetic nerves and mediate negative feedback inhibition of further norepinephrine release.

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Markers of tissue hypoperfusion in pediatric septic shock

Abstract: In this study, trends in serum bicarbonate and lactate somewhat characterized the recovery of children with septic shock. Based on our data, it is unclear how other markers may have been used to modify therapy.

Cited by 44 publications

References 27 publications

Severe Malaria: Metabolic Complications

Severe Malaria: Metabolic Complications

Combination of Acute Physiology and Chronic Health Evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock

Circulatory Emergencies: Shock

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