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https://www.readbyqxmd.com/read/28202033/use-of-stepwise-lactate-kinetics-oriented-hemodynamic-therapy-could-improve-the-clinical-outcomes-of-patients-with-sepsis-associated-hyperlactatemia
#1
Xiang Zhou, Dawei Liu, Longxiang Su, Bo Yao, Yun Long, Xiaoting Wang, Wenzhao Chai, Na Cui, Hao Wang, Xi Rui
BACKGROUND: Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation. METHODS: The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared...
February 16, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28151454/effects-of-blood-transfusion-on-oxygen-extraction-ratio-and-central-venous-saturation-in-children-after-cardiac-surgery
#2
Bana Nasser, Mohmad Tageldein, Abdulrahman AlMesned, Mohammad Kabbani
BACKGROUND: Red blood cell transfusion is common in critically ill children after cardiac surgery. Since the threshold for hemoglobin (Hb) transfusion need is not well defined, the threshold Hb level at which dependent critical oxygen uptake-to-delivery (VO2-DO2) status compensation is uncertain. OBJECTIVES: To assess the effects of blood transfusion on the oxygen extraction ratio (O2ER) and central venous oxygen saturation (ScvO2) to identify a critical O2ER value that could help us determine the critical need for blood transfusion...
January 2017: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/28149028/comparative-evaluation-of-central-venous-pressure-and-sonographic-inferior-vena-cava-variability-in-assessing-fluid-responsiveness-in-septic-shock
#3
Manjri Garg, Jyotsna Sen, Sandeep Goyal, Dhruva Chaudhry
OBJECTIVE: Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI) in comparison to central venous pressure (CVP) in predicting fluid responsiveness in septic shock. MATERIALS AND METHODS: Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive) were included...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28144579/microvascular-response-to-transfusion-in-elective-spine-surgery
#4
J Matthias Walz, Ottokar Stundner, Federico P Girardi, Bruce A Barton, Aimee R Koll-Desrosiers, Stephen O Heard, Stavros G Memtsoudis
AIM: To investigate the microvascular (skeletal muscle tissue oxygenation; SmO2) response to transfusion in patients undergoing elective complex spine surgery. METHODS: After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3 level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume (SV), cardiac output (CO), cardiac index (CI), and stroke volume variability (SVV) was performed...
January 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/27908340/end-points-of-sepsis-resuscitation
#5
REVIEW
John C Greenwood, Clinton J Orloski
Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27836261/cardiac-output-scvo2-relationship-during-sepsis-a-subtle-association
#6
EDITORIAL
Karim Bendjelid
No abstract text is available yet for this article.
October 25, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27832407/central-venous-to-arterial-carbon-dioxide-difference-and-the-effect-of-venous-hyperoxia-a-limiting-factor-or-an-additional-marker-of-severity-in-shock
#7
P Saludes, L Proença, G Gruartmoner, L Enseñat, A Pérez-Madrigal, C Espinal, J Mesquida
Central venous-to-arterial carbon dioxide difference (PcvaCO2) has demonstrated its prognostic value in critically ill patients suffering from shock, and current expert recommendations advocate for further resuscitation interventions when PcvaCO2 is elevated. PcvaCO2 combination with arterial-venous oxygen content difference (PcvaCO2/CavO2) seems to enhance its performance when assessing anaerobic metabolism. However, the fact that PCO2 values might be altered by changes in blood O2 content (the Haldane effect), has been presented as a limitation of PCO2-derived variables...
November 10, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27829180/changes-of-central-venous-oxygen-saturation-define-fluid-responsiveness-in-patients-with-septic-shock-a-prospective-observational-study
#8
Biao Xu, Xiaobo Yang, Chunyao Wang, Wei Jiang, Li Weng, Xiaoyun Hu, Jinmin Peng, Bin Du
PURPOSE: To evaluate whether the changes of central venous oxygen saturation (Scvo2) after fluid challenge can define fluid responsiveness in patients with septic shock. METHODS: In this prospective observational study, septic shock patients with invasive cardiac output monitoring requiring fluid challenge were included. Cardiac index (CI) and Scvo2 were measured before and after fluid challenges. The changes of CI (ΔCI) and the changes of Scvo2 (ΔScvo2) were calculated and analyzed using Pearson correlation...
October 19, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27821162/physiological-effects-of-invasive-ventilation-with-neurally-adjusted-ventilatory-assist-nava-in-a-crossover-study
#9
Jean-Michel Liet, François Barrière, Bénédicte Gaillard-Le Roux, Pierre Bourgoin, Arnaud Legrand, Nicolas Joram
BACKGROUND: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of assisted mechanical ventilation that delivers inspiratory pressure proportionally to the electrical activity of the diaphragm. To date, no pediatric study has focused on the effects of NAVA on hemodynamic parameters. This physiologic study with a randomized cross-over design compared hemodynamic parameters when NAVA or conventional ventilation (CV) was applied. METHODS: After a baseline period, infants received NAVA and CV in a randomized order during two consecutive 30-min periods...
November 8, 2016: BMC Pediatrics
https://www.readbyqxmd.com/read/27749764/the-predictive-ability-of-pv-aco2-gap-and-pv-aco2-ca-vo2-ratio-in-shock-a-prospective-cohort-study
#10
Mohammad Shaban, Nawal Salahuddin, Mohammad Raed Kolko, Moh'd Sharshir, Mohannad AbuRageila, Ahmed AlHussain
INTRODUCTION: Compromised tissue oxygenation leads to anaerobiosis, leading to organ failure and death. This study attempts to demonstrate the predictive abilities of the Pv-aCO2 gap and Pv-aCO2/Ca-vO2 ratio in shock patients undergoing resuscitation. METHODS: In a prospective study, consecutive patients with shock were included. Timed measurements of Pv-aCO2 gap, ScvO2, lactate and Pv-aCO2/ Ca-vO2 ratio were obtained. The association between the mortality and each variable at all intervals were analyzed...
September 29, 2016: Shock
https://www.readbyqxmd.com/read/27716694/perioperative-utility-of-goal-directed-therapy-in-high-risk-cardiac-patients-undergoing-coronary-artery-bypass-grafting-a-clinical-outcome-and-biomarker-based-study
#11
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Rawat, Yatin Mehta
Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass...
October 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27667276/-the-effect-and-factors-associated-with-outcome-of-extracorporeal-membrane-oxygenation-in-refractory-cardiogenic-shock-patients
#12
R Q Zhu, C Z Liu, J H Lu, Y P Su, S C Wen, G J Nie, Y Z Hu, L E Zuo
Objective: To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation (ECMO) in refractory cardiogenic shock patients. Methods: Patients with refractory cardiogenic shock received ECMO treatment in our hospital from May 2013 to November 2015 were retrospectively analyzed. The clinical status before ECMO support, ECMO timing, complications and outcome were observed and analyzed.The hemodynamic data and the amount of vasoactive drugs at 2 hours before ECMO support and at 2, 6, 24 and 48 hours after ECMO support were collected and compared...
September 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/27652257/the-effect-of-esmolol-on-tissue-perfusion-and-clinical-prognosis-of-patients-with-severe-sepsis-a-prospective-cohort-study
#13
Xiuling Shang, Kaiyu Wang, Jingqing Xu, Shurong Gong, Yong Ye, Kaihua Chen, Fayang Lian, Wei Chen, Rongguo Yu
Purpose. This study was aimed at investigating the effect of esmolol on tissue perfusion and the clinical prognosis of patients with severe sepsis. Materials and Methods. One hundred fifty-one patients with severe sepsis were selected and divided into the esmolol group (n = 75) or the control group (n = 76), who received conventional antiseptic shock treatment. The esmolol group received a continuous infusion of esmolol via a central venous catheter, and their heart rate (HR) was maintained at 70-100 bpm over 72 hours...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27476492/the-effect-of-blood-transfusion-on-central-venous-oxygen-saturation-in-critically-ill-patients-admitted-to-a-neurointensive-care-unit
#14
R M Surve, R Muthuchellappan, G S U Rao, M Philip
BACKGROUND: Literature suggests poorer outcomes during anaemia as well as following red blood cell transfusion (BT) in brain injured patients. Recently, central venous oxygen saturation (ScvO2 ) has been proposed as a physiological trigger to guide red BT. In this study, we looked at ScvO2 changes following BT in patients admitted to a neurointensive care unit (NICU). STUDY DESIGN: In this prospective, observational study, adult, acutely ill neurological patients of >18 years were recruited...
October 2016: Transfusion Medicine
https://www.readbyqxmd.com/read/27467272/assessment-of-the-adequacy-of-oxygen-delivery
#15
Katherine Mayer, Stephen Trzeciak, Nitin K Puri
PURPOSE OF REVIEW: This article reviews the recent literature pertaining to assessment of the adequacy of oxygen delivery in critically ill patients with circulatory shock. RECENT FINDINGS: The assessment of the adequacy of oxygen delivery has traditionally involved measurement of lactate, central (or mixed) venous oxygen saturation (ScvO2), and global hemodynamic markers such as mean arterial pressure and cardiac index. The search for noninvasive, reliable, and sensitive methods to detect derangements in oxygen delivery and utilization continues...
October 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27383316/clinical-research-about-airway-pressure-release-ventilation-for-moderate-to-severe-acute-respiratory-distress-syndrome
#16
J-Q Li, N Li, G-J Han, C-G Pan, Y-H Zhang, X-Z Shi, J-Y Xu, B Lu, M-Q Li
OBJECTIVE: To evaluate clinical effects of airway pressure release ventilation (APRV) in patients suffering from moderate to severe acute respiratory distress syndrome (ARDS).e of a patient presented with significant high aminotransferase levels due to the first human R. aeschlimannii infection ever detected in Italy. The hypothesis of rickettsiosis was made on the basis of a comprehensive medical history and was confirmed by serological tests. Molecular analyses made on a sample of hepatic tissue revealed the presence of a rickettsial species never found before in human liver...
June 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27307767/success-of-applying-early-goal-directed-therapy-for-septic-shock-patients-in-the-emergency-department
#17
Panita Worapratya, Apisit Wanjaroenchaisuk, Jutharat Joraluck, Prasit Wuthisuthimethawee
BACKGROUND: Since early goal-directed therapy (EGDT) became standard care in severe sepsis and septic shock patients in intensive care units many years ago, we suppose that the survival rate of severe sepsis and septic shock patients improves if the resuscitative procedure is quickly implemented and is initiated in the emergency room. OBJECTIVE: We aimed at recording emergency department time to improve our patient care system as well as determine the rate at which EGDT goals can be achieved...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27256604/-the-influence-of-left-ventricular-arterial-coupling-on-the-prognosis-of-elderly-patients-with-septic-shock
#18
X Y Zhou, L Li, S J Gong, Y H Yu, H W Dai, J Yan
OBJECTIVE: To investigate the influence of left ventricular-arterial coupling(VAC) on clinical prognosis of elderly patients with septic shock. METHODS: A total of 56 elderly septic shock patients were enrolled in this study, all of whom were admitted to Department of Intensive Care Unit in Zhejiang Hospital from August 2014 to October 2015.The patients were divided into two groups according to the status of left ventricular-arterial coupling when septic shock was diagnosed, which were left ventricular-arterial uncoupling group(UC group) and left ventricular-arterial coupling group(C group)...
June 2016: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/27210904/relationship-between-central-and-peripheral-venous-oxygen-saturation-and-lactate-levels-a-prospective-study
#19
Nikhil Goyal, Andrew R Taylor, Emanuel P Rivers
BACKGROUND: Optimization of tissue oxygen delivery to meet consumption demands is important in the resuscitation of critically ill patients. Central venous oxygen saturation (ScvO2) and lactate levels are often used to guide resuscitation; however, invasive monitoring is required for the former. Clinicians searching for less invasive alternatives may consider using peripheral venous oxygen saturation (SpvO2) and lactate levels as a substitute. OBJECTIVES: To determine the relationship between SpvO2 and ScvO2 and peripheral and central lactate levels...
June 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27132457/-improvement-effect-of-early-goal-directed-therapy-on-the-prognosis-in-patients-with-septic-shock
#20
Chang Li, Dong Yun
OBJECTIVE: To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality. METHODS: A retrospective controlled study was conducted. Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed. According to the International Guidelines for Management of Severe Sepsis and Septic Shock ( SSC ) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i...
November 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
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