Veno-arterial Carbon Dioxide Gradient in Human Septic Shock

Bakker, Jan; Vincent, Jean‐Louis; Gris, Philippe Luc Yves; Léon, Marc; Coffernils, Michel; Kahn, Robert J.

doi:10.1378/chest.101.2.509

Cited by 205 publications

(137 citation statements)

References 22 publications

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“…Values of P(v-a)CO 2 larger than 6 mmHg were found to be associated with poor outcome and organ dysfunctions [94,96]. Additional research on the defined clinical practicality of this variable is pending.…”

Section: Veno-arterial Carbon Dioxide Gradient (P(v-a)co 2 )mentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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Several studies have demonstrated that perioperative hemodynamic optimization (or ''goal directed therapy'') using minimally invasive hemodynamic monitoring technologies has the ability to improve postoperative patients' outcome with lower complication rates, shorter hospital lengths of stay, and lower cost of surgery. This specific concept of goal-directed therapy (GDT) uses perioperative cardiac output monitoring and manipulation of physiologic parameters (dynamic parameters of fluid responsiveness) to guide intravenous fluids and inotropic therapy with the goal of ensuring adequate tissue perfusion. Recently, the evidence related to the implementation of GDT strategies has been considered strong enough to allow for the creation of national recommendations in the UK, in France, and by the European Society of Anaesthesiology. The aims of the programs are to apply best practices to high-risk surgical patients and requires the participation of all clinicians involved in patients' care. Considering the potential clinical and economic benefits of GDT protocols and the positive recommendations from influential scientific societies, more and more hospitals around the world have become interested in implementing hemodynamic optimization in their departments. This review provides the information about the evolution of hemodynamic monitoring from invasive to the more recent noninvasive devices, and how these devices can be used in the operating rooms through well-defined algorithms of GDT.

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Section: Veno-arterial Carbon Dioxide Gradient (P(v-a)co 2 )mentioning

confidence: 99%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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“…Se postula que la hipercapnia venosa ocurriría al ser tamponados los hidrogeniones producidos por el metabolismo anaerobio, para mantener el equilibrio ácido-base en células con un potencial redox disminuido. Así como la pCO 2 arterial depende de la ventilación alveolar y del intercambio gaseoso pulmonar, la pCO 2 venosa depende del flujo circulatorio y no necesariamente de la hipoxia hipoxémica, correlacionándose inversamente al GC en falla circulatoria 14,[21][22][23][24][25][26][27][28][29][30] , hallazgo reafirmado en este modelo pediátrico. Concordantemente se ha propuesto un rol de la ΔVACO 2 en guiar la terapia de reanimación, de manera complementaria a la saturación venosa central de oxígeno 13 .…”

Section: Discussionunclassified

Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental

et al. 2012

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“…A dCO 2 more than 5 mmHg had 96% sensitivity to predict the occurrence of postoperative complications in patients with normal (71%) ScvO 2 [50]. In critically ill patients, the dCO 2 is in good inverse correlation with the CO [41], and it has also been shown to be a good predictor of bad outcome in patients with septic shock [40]. In cases like septic shock, when due to microcirculatory or mitochondrial defects, oxygen uptake is insufficient, ScvO 2 can be supranormal.…”

Section: Parameters Reflecting Vomentioning

confidence: 93%

“…The phenomenon of increased CO 2 during cardiac arrest [38] and cardiopulmonary resuscitation [39] was first described 30 years ago. As then, several authors have reported increased dCO 2 in different low flow states [40][41][42]. In oxygen debt caused anaerobic metabolism, hydrogen ions are generated through the hydrolysis of ATP to ADP and increased production of lactic acid [43].…”

Section: Parameters Reflecting Vomentioning

confidence: 99%

Multimodal individualized concept of hemodynamic monitoring

Molnár

Szabó

Németh

2017

Current Opinion in Anaesthesiology

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Purpose of reviewTo discuss the pathophysiological rationale of advanced hemodynamic monitoring in the critically ill and also to highlight the importance of a multimodal, individualized approach. Recent findingsThere are several clinical studies and animal experiments evaluating, which hemodynamic endpoint should be the best target during fluid management. Recent systematic reviews and meta-analyses also investigated the effects of advanced hemodynamic endpoints targeted hemodynamic management on outcome mainly in high-risk surgical patients. Although most of these studies report positive results, this knowledge does not seem to affect our everyday practice. According to large international surveys, most physicians still rely on inappropriate indices. One of the reasons could be that target values applied in these studies can be misleading in the individual patient. Therefore, we describe the concept of an individualized approach, in which normalizing the components of oxygen delivery are put in the context of the patients' individual response by evaluating components of oxygen consumption, and organ perfusion. SummaryAdvanced hemodynamic monitoring-based management provides a number of benefits, which could be better tailored for the patients' actual needs by putting this into a multimodal, individualized approach.

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Veno-arterial Carbon Dioxide Gradient in Human Septic Shock

Cited by 205 publications

References 22 publications

Guiding Goal-Directed Therapy

Guiding Goal-Directed Therapy

Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental

Multimodal individualized concept of hemodynamic monitoring

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