Critical care clinics
-
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.
-
Critical care clinics · Apr 2010
ReviewOxygen delivery and consumption: a macrocirculatory perspective.
Severe sepsis is a leading cause of death and resource use throughout the world. This article examines the relationship of oxygen delivery to oxygen use under varying conditions. Topics reviewed include the concept of the critical dissolved oxygen, concerns over shared measurement errors in obtaining estimates of oxygen consumption, seminal articles in this area, and the practice of early goal directed therapy.
-
Organ function is critically linked to the way tissues use available oxygen. In sepsis, tissue-related hypoxic injury is the result of hypoxemia and hypoperfusion and cytokine-mediated mitochondrial dysfunction termed cytopathic hypoxia. ⋯ Lactate is a marker of aerobic mitochondrial dysfunction and anaerobic tissue metabolism and in some circumstances is considered the fuel of choice for certain tissues. The concept of cellular metabolic derangement or cytopathic hypoxia as a potential cause for multiorgan system dysfunction in sepsis may direct efforts to optimize outcome in septic patients from the classic targets of CO, tissue perfusion, DVo(2), and Vo(2) toward moderating sepsis-related early cytokine response, maximizing mitochondrial function, and using biomarkers to monitor treatment response.
-
Critical care clinics · Apr 2010
The role of echocardiography in hemodynamic assessment of septic shock.
Echocardiography is a rapid, noninvasive, comprehensive cardiac assessment option for patients presenting with hemodynamic instability. In patients with septic shock, echocardiography can be used to guide fluid therapy by measuring collapsibility of the inferior vena cava. ⋯ Unexpected or rare findings that affect management may be revealed using focused echocardiography. This article presents national and international competency statements regarding critical care echocardiography and training resources for intensivists.