Critical care clinics
-
Critical care clinics · Apr 2010
ReviewMechanisms, detection, and potential management of microcirculatory disturbances in sepsis.
Despite improvements in resuscitation and treatment of sepsis, the morbidity and mortality remain unacceptably high. Microvascular dysfunction has been shown to play a significant role in the pathogenesis of sepsis and is a potential new target in the management of sepsis. ⋯ Bedside measurement of microcirculatory perfusion has become simpler and more accessible, and may provide key insights into prognosis in sepsis and guide future therapeutics, much like mean arterial pressure (MAP), lactate, and mixed central oxygen saturation (SvO(2)) do now. The authors review here the role of microcirculatory dysfunction in sepsis and its potential role as a therapeutic target in sepsis.
-
Hypotension and shock are important issues confronting the intensivist. Volume overload can have dire consequences such as decreased gas exchange and increased myocardial dysfunction. This article explores dynamic means of determining preload responsiveness.
-
Critical care clinics · Apr 2010
Optimizing hemodynamic support in septic shock using central and mixed venous oxygen saturation.
Global tissue hypoxia is one of the most important factors in the development of multisystem organ dysfunction. In hemodynamically unstable critically ill patients, central venous oxygen saturation (Scvo(2)) and mixed venous oxygen saturation (Svo(2)) monitoring has been shown to be a better indicator of global tissue hypoxia than vital signs and other clinical parameters alone. Svo(2) is probably more representative of global tissue oxygenation, whereas Scvo(2), is less invasive. Svo(2) and Scvo(2) monitoring can have diagnostic and therapeutic uses in understanding the efficacy of interventions in treating critically ill, hemodynamically unstable patients.
-
Critical care clinics · Apr 2010
ReviewLactic acidosis: recognition, kinetics, and associated prognosis.
Lactic acidosis is a common condition encountered by critical care providers. Elevated lactate and decreased lactate clearance are important for prognostication. ⋯ Lactate, in and of itself, is unlikely to be harmful and is a preferred fuel for many cells. Treatment of lactic acidosis continues to be aimed the underlying source.
-
Critical care clinics · Apr 2010
ReviewNoninvasive monitoring cardiac output using partial CO(2) rebreathing.
This article reviews use of partial carbon dioxide rebreathing devices to determine cardiac output and their application for hemodynamic monitoring in the ICU and operating room. The primary focus is on the NICO monitoring device. Compared with conventional cardiac output methods, these techniques are noninvasive, easily automated, and provide real-time and continuous cardiac output monitoring. The advantages and limitations of each technique are different discussed.