Sepsis and septic shock – is a microcirculation a main player?

Lipińska-Gediga, Małgorzata

doi:10.5603/ait.a2016.0037

Cited by 42 publications

(27 citation statements)

References 26 publications

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“…36 The changes seen in endothelial injury include loss of vascular tone, capillary obstruction by platelet or fibrin clots, as well as the degradation of heparan sulfate leading to a pro-coagulant state. 37 Coagulopathy may be another symptom of liver disease. Several factors may contribute to hemostatic changes in liver disease (Table 1).…”

Section: Coagulopathymentioning

confidence: 99%

Liver dysfunction in sepsis

et al. 2018

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Despite continuous progress in medicine, sepsis remains the main cause of deaths in the intensive care unit. Liver failure complicating sepsis/septic shock has a significant impact on mortality in this group of patients. The pathophysiology of sepsis-associated liver dysfunction is very complicated and still not well understood. According to the Surviving Sepsis Campaign (SSC) Guidelines, the diagnosis of liver dysfunction during sepsis is based on the increase in bilirubin concentration >2 mg/dL and the occurrence of coagulation disorders with INR > 1.5. The lack of specificity and ability to distinguish acute liver failure from previous liver dysfunction disqualifies bilirubin as a single parameter reflecting the complex liver function. Clinical manifestations of sepsis-associated liver dysfunction include hypoxic hepatitis, sepsis-induced cholestasis and dysfunction of protein synthesis manifesting with, e.g., coagulopathies. Detoxifying liver dysfunction, which is associated with an increase in serum ammonia concentration, manifesting with e.g., confusion, loss of consciousness and hepatic encephalopathy, may be disguised by analgosedation used in the intensive care unit. To determine a liver dysfunction in a critically ill patient, the concept of shock liver may be used. It is a complex syndrome of hemodynamic, cellular, molecular and immunologic changes leading to severe liver hypoxia. In clinical practice, there is no standardized diagnostic panel that would allow for an early, clear diagnosis of acute liver dysfunction, and there is no therapeutic panel enabling the full restoration of damaged liver function. The aim of the article is to present the pathophysiology and clinical manifestations of sepsis-associated liver dysfunction.

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Section: Coagulopathymentioning

confidence: 99%

Liver dysfunction in sepsis

et al. 2018

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“…[ 34 ] Also, Correcting microcirculation disorders plays a vital role in the prognosis of shock patients. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…In shock, macrocirculation changes and microcirculation dysfunction are simultaneously involved in the pathophysiology of organ failure. [ 12 ]…”

Section: Introductionmentioning

confidence: 99%

Effect of shenfu injection on microcirculation in shock patients

Zhang¹,

Guo²,

Zhang³

et al. 2020

Medicine

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Background: Shock is a major public health problem worldwide. At present, the morbidity and mortality of shock patients are relatively high. Vasomotor dysfunction is 1 of the key pathological aspects of shock. Shenfu injection has been widely used for the treatment of shock in China. Pharmacological studies have suggested that Shenfu injection can reduce peripheral circulation resistance and improve microcirculation. The purpose of this study is to evaluate the effect and safety of Shenfu injection on the microcirculation of patients with shock. Methods: This review summarizes and meta-analyzes randomized controlled trials of Shenfu injection for the treatment of shock.Searched the following electronic databases: PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang Data. The Cochrane risk assessment tool was used to evaluate the methodological quality of randomized controlled trials. All tests are analyzed according to the standards of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software and Grading of Recommendations Assessment, Development, and Evaluation pro GDT web solution are used for data synthesis and analysis. Results: This review focuses on the effects of Shenfu injection on the microcirculation of shock patients (blood lactic acid level, arteriovenous oxygen saturation, arteriovenous carbon dioxide partial pressure difference, sublingual microcirculation), 28-day mortality, 28-day ICU hospitalization and adverse reaction rate. Conclusion: This review provides a clear basis for evaluating the impact of Shenfu injection on the microcirculation of shock patients, as well as the effectiveness and safety of the treatment.

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“…Clinical signs of septic shock include toxemia, tachycardia, oliguria, high-cardiac-output state, reduced vascular resistance, impaired function of the immune system and multiple organ failure. 17 Hypoperfusion is accompanied by volume overload of the myocardium, a signifi cant reduction in its contractibility, the elevated level of central venous pressure, and a gradual reduction in blood pressure. 18,19 When analyzing the patient's condition during hospitalization, there were observed the classical signs of septic shock manifested themselves as dehydration, arterial hypotension <90 mm Hg, tachycardia >90 bpm, increased breathing rate >20/min, oliguria.…”

Section: Discussionmentioning

confidence: 99%

Acute lower limb ischemia secondary to diffuse peritonitis

Berek¹,

Kopolovets²,

Sihotský³

2020

Cor Vasa

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Akútna ischémia dolných končatín je väčšinou spôsobená embóliou, trombózou a traumatickými zraneniami. Samostatnú skupinu tvoria pacienti so sekundárnou akútnou ischémiou končatín k inému základnému ochoreniu. Prezentácia kazuistiky: V tomto článku popisujeme kazuistiku 72-ročnej ženy, ktorá bola hospitalizovaná na Klinike cievnej chirurgie s akútnou ischémiou dolnej končatíny. Podľa predchádzajúcej anamnézy jeden deň pred hospitalizáciou pacientka bola vyšetrená chirurgom pre bolesť brucha: bez príznakov peritonitídy. Bola realizovaná ultrazvuková diagnostika brucha, kde sa nevyskytol žiaden akútny nález; podľa laboratorných testov boli zvýšené leukocyty na 18,2 × 10 9 /I. Nasledujúci deň pacientku doniesli na konzultáciu k cievnému chirurgovi kvôli bolesti a necitlivosti pravej dolnej končatiny. Vzhľadom na bolesť brucha a zvýšený počet leukocytov bola vykonaná v urgentnom režime CT angiografi a, na základe ktorej bolo diagnostikované pneumoperitoneum a akútny uzáver artérií pravej dolnej končatiny. Vykonaná simultanná emergentná operácia: trombektómia tepien dolných končatín a laparotómia, kde bola diagnostikovaná perforácia pylorusa, difúzna peritonitída. Bohužiaľ pacientka zomrela v dôsledku hemodynamického zhoršenia a rozvoja polyorganného zlyhania na základe septického šoku. Záver: Táto kazuistika predstavuje vývoj akútnej ischémie pravej dolnej končatiny ako komplikácie difúznej peritonitídy. Septický šok spôsobil dehydratáciu pacientky, zhoršenie hemokoagulačných parametrov a rozvoj sekundárnej trombózy artérií pravej dolnej končatiny.

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Sepsis and septic shock – is a microcirculation a main player?

Cited by 42 publications

References 26 publications

Liver dysfunction in sepsis

Liver dysfunction in sepsis

Effect of shenfu injection on microcirculation in shock patients

Acute lower limb ischemia secondary to diffuse peritonitis

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