Revue médicale suisse
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Revue médicale suisse · Dec 2011
Review[Pathophysiological mechanisms and treatment of septic shock-induced vasoplegia].
The hemodynamics of septic shock is characterized by a primary reduction of vascular tone, which defines vasoplegia. Septic vasoplegia is due to reduced endogenous production of vasopressin, as well as to the overproduction of vasodilating molecules (nitric oxide, prostacyclin, peroxynitrite and kynurenine) and the opening of ATP-sensitive potassium channels. ⋯ Further agents can improve the vascular responsiveness to catecholamines, most notably low doses hydrocortisone, and, to a lesser extent, activated protein C. Further, innovative therapies, based on recent understanding of pathophysiological mechanisms, might become useful agents to treat septic vasoplegia in the future.
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Revue médicale suisse · Dec 2011
Editorial Historical Article[What's the usefulness of Intensive care/resuscitation unit in 2012?].
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In intensive care units, death occurs after a medical decision of treatment limitation in a great majority of patients. In this context, taking care of the patient and his relatives is ethically, practically and emotionally complex. End of life is a well known factor of conflict, burnout and stress among medical and nursing teams in the ICU. The recommendations described in the following article are expected to clarify the roles and practices of the professionals involved in end of life procedures in the ICU.
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The Extra corporeal membrane oxygenation (ECMO) was initially proposed as a technique of respiratory support using an external membrane oxygenator. With time, it has also become a technique of cardiorespiratory support to ensure both gas exchange and organ perfusion until the restoration of organs function. ⋯ The circuit includes a non occlusive centrifugal pump, an oxygenator for an enrichment of O2 and elimination of CO2 and cannulas for drainage and re-injection. Recently, the establishment of such assistance became possible percutaneously, allowing it to be initiated at the intensive care bedside or even before in-hospital admission.
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Despite some progress, the mortality of severe sepsis and septic shock remains high. Immunotherapy directed against inflammatory mediators failed, but new treatments more specifically tailored to individual situations are actively investigated. ⋯ Combined with the clinical course, "PCT" allows to tailor individually the duration of antibiotic therapy in ICU patients. This still contested innovative approach significantly reduces overall exposure to antibiotics.