Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Oct 1999
Review[Recent clinical trials for sepsis: analysis of the results and future perspectives].
Recent clinical trials with experimental immunotherapeutic agents for sepsis have not proven their overall benefit yet although some studies suggested significant effect of these antisepsis therapies. This review article summarizes the results of these trials, their analysis, lessons learned from past failure, and future perspectives for immunotherapies as anti-sepsis treatments.
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Disturbances in tissue perfusion and oxygenation are known to occur during shock. To treat shock properly, it is necessary to have a good understanding of its pathophysiological characteristics. By monitoring cardiac output and oxygen delivery, we can assess the systemic oxygen transport to the tissues, while mixed venous oxygen saturation provides an index of the systemic oxygen balance between oxygen delivery and consumption. ⋯ The use of near-infrared spectroscopy may allow simultaneous, noninvasive monitoring of regional tissue oxygenation and energy levels. There exists a wide variety of viable options for the monitoring of shock, both systemically and regionally. This increases the chances of successful treatment.
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Shock is defined as organ failure due to the disturbance of perfusion in vital organs and various humoral mediators. Multiple organ failure (MOF) is a typical pathophysiologic condition subsequent to shock. Therefore the severity of shock should be evaluated based on the severity of organ failure. ⋯ The CIS is derived from the scoring of three parameters of intracellular metabolism: the arterial ketone body ratio (AKBR); osmolality gap (OG); and blood lactate level. The CIS correlates well with the degree of organ failure and mortality rate in patients with MOF and accurately indicates the severity of shock in individual patients. Our results suggest that the CIS is a useful scoring system based on the pathophysiology of shock, not only to predict the outcome and evaluate the severity in patients with shock and MOF but also to predict the development of MOF subsequent to shock.
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Nihon Geka Gakkai zasshi · Oct 1999
Review[Pathophysiology and strategy of shock in terms of tissue oxygen metabolism].
In both septic shock and hypovolemic shock, global oxygen consumption is characterized by the supply dependency phenomenon, which suggests tissue hypoxia. The conventional measurements of blood lactate level, oxygen delivery/oxygen consumption, and mixed venous oxygen saturation may not provide reliable information on the adequacy of tissue oxygenation. The intestinal mucosal villus is particularly vulnerable to a reduction in oxygen delivery because of the countercurrent mechanism. ⋯ Further studies are needed to demonstrate the effects of other agents, such as angiotensin-converting enzyme inhibitor and vasodilator prostaglandins. Plasma volume expansion with colloid solution may improve the splanchnic microvascular blood flow. Older stored-blood transfusion, however, may lead to tissue hypoxia.