Monitoring Tissue Perfusion, Oxygenation, and Metabolism in Critically Ill Patients

Ekbal, Nasirul J.; Dyson, Alex; Black, Claire; Singer, Mervyn

doi:10.1378/chest.12-1849

Cited by 41 publications

(25 citation statements)

References 77 publications

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“…Promising real-time in vivo techniques include NADH fluorometry, magnetic resonance spectroscopy (MRS), and near infrared spectroscopy to measure COX redox state (42). Mitochondrial O 2 tension can be estimated by measurement of the phosphorescence decay time of sensors containing protoporphyrin IX (43).…”

Section: Resultsmentioning

confidence: 99%

Mitochondrial Function in Sepsis

Arulkumaran

Deutschman

Pinsky

et al. 2016

Shock

143

123

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Mitochondria are an essential part of the cellular infrastructure, being the primary site for high energy adenosine triphosphate (ATP) production through oxidative phosphorylation. Clearly, in severe systemic inflammatory states, like sepsis, cellular metabolism is usually altered and end organ dysfunction not only common but predictive of long term morbidity and mortality. Clearly, interest is mitochondrial function both as a target for intracellular injury and response to extrinsic stress have been a major focus of basic science and clinical research into the pathophysiology of acute illness. However, mitochondria have multiple metabolic and signaling functions that may be central in both the expression of sepsis and its ultimate outcome. In this review, the authors address five primary questions centered on the role of mitochondria in sepsis. This review should be used as both a summary source in placing mitochondrial physiology within the context of acute illness and as a focal point for addressing new research into diagnostic and treatment opportunities these insights provide.

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Section: Resultsmentioning

confidence: 99%

Mitochondrial Function in Sepsis

Arulkumaran

Deutschman

Pinsky

et al. 2016

Shock

143

123

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show abstract

“…Beside macrohemodynamic measurements, regional perfusion monitoring systems have become more and more common in perioperative care of critical ill patients [16]. The participating centers – especially university hospitals - favour continuous measurement of central- or mixed-venous saturation and the use of cerebral oximetry measurement systems.…”

Section: Discussionmentioning

confidence: 99%

Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

et al. 2014

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BackgroundManagement of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.MethodsBetween April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.Results51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).ConclusionsChoice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.

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“…The decrease in CI secondary to vagally mediated decreases in HR may also affect tissue perfusion after dexmedetomidine administration 1,2 ; therefore, studies to evaluate the consequences of dexmedetomidine administration without concurrent administration of anticholinergics in hypovolemic patients are warranted. Also, critically ill patients with clinically normal global perfusion variables can have compromised regional perfusion, 32 and additional studies are necessary to determine whether dexmedetomidine administration exacerbates the impairment of regional perfusion in such patients.…”

Section: Discussionmentioning

confidence: 99%