Central Hemodynamics and Microcirculation in Critical Conditions

Abstract

ВведениеПри любом критическом состоянии ключевой проблемой в первую очередь является нарушение пер фузии тканей, на решение которой направлен весь ком плекс интенсивной терапии [1][2][3][4][5][6][7]. Ведь при снижении уровня тканевого кровотока ниже пороговых значений происходящие метаболические, биохимические и энзи матические клеточные нарушения приводят к разви тию полиорганной недостаточности, а без адекватного лечения -к летальному исходу [1, 3]. Параметры мак рогемодинамики, будь то артериальное давление, час тота сердечных сокращений, сердечный индекс или Results. The pattern of central hemodynamic and microcirculatory disorders varies with the trigger that has led to a critical condition. Central hemodynamics should be stabilized to ensure the average level of tissue perfusion in vic tims with severe concomitant injury. In general purulent peritonitis, microcirculatory disorders may persist even if the macrohemodynamic parameters are normal. Conclusion. The macrohemodynamic and microcirculatory differ ences obtained during the study suggest that a complex of intensive therapy should be differentiated and, if the lat ter is used, it is necessary not only to be based on the central hemodynamics, but also to take into consideration functional changes in microcirculation.

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

“…One of the key moments in the transformation of the AP clinical picture into its severe course is the transfer of local inflammatory processes to the systemic inflammatory response. Historically, the comprehension of this process occurred at the beginning of the XXI century when a concept of interaction of systemic inflammatory response and multiple organ dysfunction was formulated [20][21][22]28]. The mechanism of multiple organ dysfunction development consisting of 5 stages was proposed.…”

“…Sepsis is known to be a critical state associated with endogenous intoxication which causes mitochondrial dysfunction, triggers the mechanisms of apoptosis and immunodepression [19,22,[29][30][31]. The complex of these pathogenic mechanisms is maintained and regulated by the mediators of systemic inflammation, coagulation, reprogramming of immunocompetent cell genes, and disorders of physiological functions and organ activity in this case go beyond the limits of regulatory capabilities to such an extent that the function regulation systems are not able to correct spontaneously and demand partial or complete replacement (prosthetic treatment) [31][32][33][34][35][36].…”

“…The emerging disorders of vascular tone regulation and changes in the vascular wall permeability result in the impairment of organ perfusion, in particular, mesenteric, pulmonary, and cerebral blood supply [ 1 , 4 , 21 ]. There occurs massive sequestration of fluid to the interstitial space, postperitoneum cellular tissue, abdominal and pleural cavities with the development of heavy hypovolemia and electrolyte disorders in combination with the collection of excessive substances with a toxic effect in the liquid body media causing metabolic disturbance at the cellular and subcellular levels and, ultimately, mitochondrial dysfunction [ 20 , 22 ].…”

“…Local inflammatory process and impairment of intestinal mucosa microcirculation, developing and progressive intestinal paresis contribute to translocation of bacterial microflora and the occurrence of endotoxemia triggering an entire pool of metabolic changes [ 22 – 27 ].…”

Changes in Hemodynamics During the Course of Surfactant Therapy in Patients With Hormone-Dependent Asthma

“…Тяжелое течение БА подразумевает неизбежное ремоделирование сердечно-сосудистой системы, а длительное применение ГКС оказывает влияние как на состояние сосудистой стенки, так и макрогемоциркуляцию [4,5]. Тесная взаимосвязь дыхательной и сердечно-сосудистой систем подразумевает изменение их статуса как на фоне прогрессирования функциональной недостаточности одной из них, так и в процессе ремиссии [1,2].…”