How to choose the therapeutic goals to improve tissue perfusion in septic shock

Assunção, Murillo Santucci César de; Corrêa, Thiago Domingos; Bravim, Bruno de Arruda; Silva, Eliézer

doi:10.1590/s1679-45082015rw3148

Cited by 11 publications

(12 citation statements)

References 40 publications

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“…One possible explanation for such divergence is that the techniques used in the studies for perfusion assessment have clear operational differences and evaluate different microcirculation levels and differences in the tissues themselves [ 8 ]. Hence, there are different vasoactive mediators between sublingual and cutaneous tissues [ 34 , 41 ], resulting in various degrees of impairment, and accordingly determine disparities in regional blood flow between tissues [ 42 ]. In fact, a critical study found no significant correlation between skin and sublingual perfusion in patients with sepsis, corroborating this hypothesis [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

et al. 2020

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Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r =-0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.

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Section: Discussionmentioning

confidence: 99%

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

et al. 2020

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“…From a clinical point of view, central venous oxygen saturation (ScvO 2 ) has an inverse relationship with oxygen extraction ratio. [ 15 ] In clinical setting, ScvO 2 <70% indicates inadequate DO 2 to meet metabolic demand. Currently, there are mixed findings on ScvO 2 >70% targeted resuscitation on mortality.…”

Section: Discussionmentioning

confidence: 99%

Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase

et al. 2022

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OBJECTIVES: The objectives were to study the effect of aggressive resuscitation using normal saline on hemodynamics, serum atrial natriuretic peptide (ANP), syndecan-1 (marker of endothelial glycocalyx shedding), and extravascular lung water index (ELWI) following hemorrhagic shock. METHODS: Eleven male piglets ( Sus scrofa ) underwent blood drawing to create 20% drop in mean arterial pressure (MAP). Two-phase resuscitation was performed: Phase 1 using normal saline of an equal volume of blood drawn to create shock and Phase 2 using 40 ml/kg BW of normal saline to simulate hypervolemia and hemodilution. Heart rate, MAP, cardiac index (CI), systemic vascular resistance index, oxygen delivery (DO 2 ), global end-diastolic volume index, ELWI, hemoglobin (Hb), lactate, ANP, and syndecan-1 at each phase and up to 60 min following Phase 2 resuscitation were recorded. RESULTS: Phase 2 resuscitation significantly decreased Hb concentration ( P = 0.006), however, DO 2 was maintained ( P = 1.000). CI increased from shock to Phase 1 ( P = 0.029) and further increase in Phase 2 resuscitation ( P = 0.001). Overall, there was a transient increase of ANP following Phase 1 resuscitation, from 85.20 ± 40.86 ng/L at baseline to 106.42 ± 33.71 ng/L ( P = 0.260). Serum syndecan-1 and ELWI change at all phases were not significant. CONCLUSIONS: We demonstrate compensatory protective mechanism despite overzealous fluid resuscitation. Compensatory increased CI despite decreased Hb maintained DO 2 . In the absence of inflammation, serum ANP did not increase significantly, no glycocalyx shedding occurred, subsequently no change in ELWI. We show that factors other than volume overload are more dominant in causing glycocalyx shedding.

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“…Destaca-se que a pouca familiaridade com a definição e com os sinais e sintomas de sepse, insere-se como uma característica que não está restrita aos enfermeiros. Um estudo brasileiro que avaliou o conhecimento dos médicos sobre sepse concluiu que eles apresentam dificuldade em reconhecer a sepse e sepse grave, provavelmente devido à dificuldade de reconhecer a disfunção de órgãos e a ausência de conhecimento de que a disfunção de órgãos define sepse grave [23].…”

Section: Discussionunclassified

Conhecimento de enfermeiros sobre os diferentes estágios clínicos da sepse: estudo descritivo

Areal¹,

Toledo²,

Souza³

et al. 2019

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Introdução: A Sepse é definida como uma resposta sistêmica a uma doença infecciosa, cuja incidência vem aumentando entre os indivíduos. Para os pacientes sépticos uma adequada assistência de enfermagem, baseada em conhecimento e habilidades técnico-científicas, possui um papel fundamental na evolução positiva do quadro clínico. Objetivo: Identificar o conhecimento de enfermeiros sobre os diferentes estágios clínicos da sepse. Métodos: Estudo descritivo, realizado entre março e maio de 2017 com enfermeiros de uma unidade hospitalar da Zona da Mata Mineira. Os dados foram coletados utilizando questionário semiestruturado com questões no formato de caso clínico abordando o conhecimento dos diferentes estágios clínicos da sepse e a identificação dos seus sinais e sintomas. Utilizou-se estatística descritiva para análise dos dados. Resultados: Dos 23 enfermeiros entrevistados, 19 (82,6%) afirmaram ter conhecimento moderado sobre a temática. Em relação ao papel da faculdade na troca de conhecimentos, 15 (65,2%) enfermeiros alegaram que pouco conhecimento foi adquirido enquanto graduandos. Apenas 10 (43,5%) enfermeiros identificaram corretamente algum dos casos clínicos relacionado à sepse. Conclusão: Há dificuldade na aplicabilidade clínica dos conceitos da sepse e seus estágios clínicos pelos enfermeiros, o que contribui para um atraso na identificação precoce dos casos e piora do prognóstico.Palavras-chave: sepse, enfermagem, conhecimento, saúde pública.

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How to choose the therapeutic goals to improve tissue perfusion in septic shock

Cited by 11 publications

References 40 publications

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase

Conhecimento de enfermeiros sobre os diferentes estágios clínicos da sepse: estudo descritivo

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How to choose the therapeutic goals to improve tissue perfusion in septic shock

Cited by 11 publications

References 40 publications

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase

Conhecimento de enfermeiros sobre os diferentes estágios clí­nicos da sepse: estudo descritivo

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Conhecimento de enfermeiros sobre os diferentes estágios clínicos da sepse: estudo descritivo