Nava TJR, Limón MAL, Bagatella BEM

Language: Spanish
References: 33
Page: 79-83
PDF size: 129.49 Kb.

ABSTRACT

The study aims to identify the microcirculatory disturbances in patients with severe sepsis in the Intensive Care Unit of Hospital Regional General “Ignacio Zaragoza” ISSSTE, are assessed to patients admitted to hospital on April 1^st 2007 to April 30^th 2008, between 18 and 70 years, excluding patients with chronic obstructive pulmonary disease, with the support of norepinephrine or dopamine dose alpha and cardiac arrest. Observational, prospective, descriptive, open and longitudinal. 35 patients, 18 men and 17 women, average 57.8 years, 72.62 kg, and 1.65 m. Will calculate the oxygen consumption of blood, hair and venous, arteriovenous oxygen difference, rate of oxygen extraction, transport of oxygen and oxygen consumption in the first 24 hours of diagnosis. They were altered with statistical significance p ‹ 0.05, excluding the Index of oxygen extraction, transportation and consumption of oxygen. The results correspond to the literature, in which the changes are reflected in the microcirculation before 24 hours with significant changes, characterized by an increase in cardiac output as a compensating, impaired the extraction of oxygen, decreased oxygen consumption decrease in the difference arteriovenous oxygen.

REFERENCES

1. Ince C, Sinaasappel M. Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med Volume 27(7), July 1999, pp. 1369-1377.

2. Dantzker DR et al. Adequacy of tissue oxygenation. Crit Care Med 1993; 21 (suppl): 540-543.

3. Trzeciak S, Bajaj JS et al. Microcirculatory perfusion in severe sepsis does not correlate with lactate. Crit Care Med Volume 32(12) Supplement, December 2004, pA156.

4. Trzeciak S, Dellinger RP et al. The relation between microcirculatory perfusion indices and global oxygen transport parameters in patients with sepsis. Crit Care Med Volume 33(12) Supplement, December 2005, pA156.

5. Trzeciak S, Bajaj JS et al. Microcirculatory perfusion in severe sepsis correlates with hemodynamic parameters. Crit Care Med Volume 32(12) Supplement, December 2004, pA156.

6. Abraham EMD, Singer MMD et al. Mechanisms of sepsis-induced organ dysfunction. Crit Care Med Volume 35(10), October 2007, pp 2408-2416.

7. Kern JW, Shoemaker WC et al. Metaanalysis of hemodynamic optimization in high-risk patients. Crit Care Med 2002; 30: 1686-92.

8. Hotchkiss RS, Karl IE et al. The pathophysiology and treatment of sepsis. N Engl J Med 2003; 348: 138-50.

9. Russell JA et al. Drug therapy: Management of sepsis. N Engl J Med 2006; 355: 1699-713.

10. Alberti C, Brun-Buisson C, Burchardi H et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002; 28: 108-21.

11. Reinhart K, Bayer O, Brunkhorst F et al. Markers of endothelial damage in organ dysfunction and sepsis. Crit Care Med 2002; 30: 302-12.

12. Lever, Andrew et al. Sepsis: definition, epidemiology, and diagnosis. BMJ 2007; 335: 879-83.

13. Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-77.

14. Bochud PY, Calandra T et al. Pathogenesis of sepsis: new concepts and implications for future treatment. BMJ 2003; 326: 262-6.

15. Tappy, Luc MD et al. Substrate utilization in sepsis and multiple organ failure. Crit Care Med 2007; 35: 531-34.

16. Dellinger RP, Carlet JM et al. Surving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32: 858-73.

17. Glauser, Michel P et al. Pathophysiologic basis of sepsis. Considerations for future strategies of intervention. Crit Care Med 2000; 28: 4-8.

18. Balk RA et al. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Med 2000; 16 (2): 337-52.

19. Deith EA et al. Multiple organ failure: pathophysiology and potential future therapy. Ann Surg 1992; 216: 117-34.

20. Egbert GM, Tanja MDJ et al. Clinical Microvascular monitoring: A bright future without a future? Crit Care Med 2009; 37 (1): 2980-2981.

21. Kienbaum P, Peters J et al. Endothelium-dependent vascular dysfunction in septic patients. Anaesthesia 2008: 63 (8); 884-885.

22. Trzeciak S, Cinel I et al. Resuscitating the Microcirculation in sepsis. The central role of nitric oxide, emerging concepts for novel therapies, and challenges for clinical trials. Academic Emergency Medicine 2008; 15 (5): 399-413.

23. Trzeciak S, Dellinger RP et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: Relation ship to hemodynamics, oxigen transport and survival. Annals of Emergency Medicine 2007; 49 (1): 88-98.

24. Mariscalco MM et al. Unlocking (perhaps unblocking) the microcirculation in sepsis. Crit Care Med 2006; 34(2): 561-562.

25. Bracco D, Dubois M et al. Hemodynamic support in septic shock: Is restoring a normal blood pressure the right target? Crit Care Med 2005; 33(9): 2113-2115.

26. Spanos A, Jhanji S et al. Early microvascular changes in sepsis and severe sepsis. Shock 2010; 33: 387-91.

27. Stafanec T et al. Endothelial apoptosis. Chest 2000; 117 (3): 841-54.

28. Marshall JC et al. Inflammation, coagulopathy, and the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med 2001; 29 (7): 599-606.

29. Hotchkiss RS, Swanson PE et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999; 27: 1230-51.

30. Mahidhara Raja et al. Apoptosis in sepsis. Crit Care Med 2000; 28: 105-13.

31. Hotchkiss RS et al. Endothelial cell apoptosis in sepsis. Crit Care Med 2002; 30: 225-28.

32. Oberholzer C et al. Apoptosis in sepsis: A new target for therapeutic exploration. FASEB 2001; 15: 879-92.

33. Papathanassoglou EDE, Moynihan JA et al. Does programmed cell death (apoptosis) play a role in the development of multiple organ dysfunction in critically ill patients? A review and theoretical framework. Crit Care Med 2000; 28 (2): 537-49.