Increasing stress volume vs. increasing tissue perfusion in septic patients

Abstract

video-laryngoscopy and/or fibre optic laryngoscopy. Further studies are required to validate this new composite DTI score.A limitation with our study is that a relatively low percentage of male patients (37.5%) was included.In conclusion, in the context of a composite DTI score, TT may help to identify patients at risk of DTI and allow preparation for establishing a safe strategy in advance.

Relationship of Effective Circulating Volume with Sublingual Red Blood Cell Velocity and Microvessel Pressure Difference: A Clinical Investigation and Computational Fluid Dynamics Modeling

“…On the contrary, a higher Pmca (> 14 mmHg) may be the result of excessive vasoconstriction, eventually resulting in hemodynamic incoherence and tissue hypoperfusion. These can also explain the detrimental effects of higher doses of vasoconstrictive agents and support the recent trend towards a perfusion-centered resuscitation strategy instead of standard pressure-guided treatment [ 16 , 17 , 52 , 53 ].…”

“…In our study with patients in a dynamic hemodynamic equilibrium, a Pmca value < 14 mmHg was correlated with higher RBC velocity, probably due to an increase in vascular capacitance and sublingual vessel diameter and/or an increase in heart efficiency. However, there must always be a limit under which decreases in Pmca and venous return impair microcirculatory blood flow [ 11 , 12 , 16 , 17 , 18 , 20 , 51 ]. On the contrary, a higher Pmca (> 14 mmHg) may be the result of excessive vasoconstriction, eventually resulting in hemodynamic incoherence and tissue hypoperfusion.…”

“…Other elegant studies have shown that hypoxia and hypercapnia increase mean circulatory filling pressure (Pmcf) and vascular capacitance [ 11 , 12 ], enhancing microcirculatory flow through a physiological adaptation to match oxygen delivery to demand [ 13 , 14 ]. These data could explain, in part, the vessel cluster synchronization in the microcirculatory blood flow of some organs, which changes depending on the condition of the vascular network and the blood pressure (hemodynamic coupling) [ 15 ], suggesting an interplay between effective circulating volume and tissue perfusion [ 11 , 13 , 14 , 16 , 17 , 18 ].…”

Association of vasopressors with mortality in critically ill patients with COVID-19: a systematic review and meta-analysis

“…A possible explanation for the association of vasopressors with mortality may lie in the microcirculation [ 68 – 77 ]. The physiological pulsatile shear stress from normal laminar flow has a pivotal role in maintaining normal endothelial function and the expression of ACE2s and other anticoagulant/antithrombotic or antioxidant substances [ 78 ].…”

General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest

“…In critically ill patients, mean arterial pressure (MAP) represents the entry pressure for the perfusion of most organs and should be maintained >65–70 mmHg [ 116 , 117 , 118 ]. Although higher MAP levels may be required in patients with brain injury or persistent hypoperfusion (e.g., progressing acute kidney injury or altered mental status) [ 119 , 120 ], adequate circulatory volume, absence of left ventricular outflow tract obstruction, and microcirculatory flow and responsiveness (if possible) should be ideally assessed before using a vasopressor challenge, especially in patients treated with TTM [ 77 , 121 , 122 , 123 ]. Considering that organ perfusion pressure is influenced by MAP and venous pressure, maintaining an optimal central venous pressure may facilitate adequate oxygen delivery.…”