Critical care clinics
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Sepsis is among the most common causes of death in patients in intensive care units in North America and Europe. In the United States, it accounts for upwards of 250,000 deaths each year. Investigations into the pathobiology of sepsis have most recently focused on common cellular and subcellular processes. ⋯ What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive.
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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.
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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.
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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.