31. |
Microcirculatory oxygenation and shunting in sepsis and shock |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1369-1377
Can Ince,
Michiel Sinaasappel,
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摘要:
ObjectiveTo review optical spectroscopic techniques for assessment of the determinants of tissue oxygenation and to evaluate the notion that the disturbances in oxygen pathways in sepsis can be accounted for by enhanced functional shunting of parts of the microcirculation.Data ResourcesExperimental data from previous research and the literature were analyzed.Study SelectionThe data selected pertained to a) whether cellular distress in sepsis is caused by tissue hypoxia or disturbed metabolic pathways, b) optical spectroscopic techniques used to study microcirculatory oxygenation, and c) possible mechanisms underlying shunting of the microcirculation in hypoxemia and sepsis.Study SynthesisDespite resuscitation of oxygen-derived variables, signs of regional tissue hypoxia persist in sepsis. The mechanisms underlying this condition are expected to be associated with oxygen pathways in the microcirculation. Optical spectroscopic techniques are providing new insights into these mechanisms. These include absorption spectroscopy for hemoglobin saturation of erythrocytes, reduced nicotinamide adenine dinucleotide fluorescence for tissue mitochondrial bioenergetics, and palladium-porphyrin phosphorescence for microvascular PO2. Reduced nicotinamide adenine dinucleotide videofluorescence studies have shown the heterogeneous nature of hypoxia. Measurement of gut microvascular PO2in pigs has shown the development of a PO2gap between microvascular PO2and venous PO2during hemorrhage and endotoxemia, with a larger gap occurring in sepsis than in hemorrhage. It is hypothesized that this difference is caused by the enhanced shunting of the microcirculation present in sepsis.ConclusionsMicrocirculatory distress may form one of the earliest stages in the progress of sepsis to multiple organ failure, and shunting of the microcirculation may be an important contributing factor to this development. To evaluate the severity of microcirculatory distress and the effectiveness of resuscitation strategies, new clinical technologies aimed at the microcirculation will need to be developed. It is anticipated that optical spectroscopy will play a major role in the development of such tools. (Crit Care Med 1999; 27:1369-1377)
ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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32. |
ATTENTIONADVERTISERS |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1377-1377
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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33. |
Right ventricular rupture during closed-chest cardiopulmonary resuscitation after pneumonectomy with pericardiotomyA case report |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1378-1379
Paul Martin,
Kempen Richard,
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摘要:
SettingThe collapse of a patient immediately after right pneumonectomy with right pericardiotomy resulted in closed-chest cardiopulmonary resuscitation, subsequent thoracotomy, and demise secondary to right ventricular rupture.InterventionsClosed-chest resuscitation with opened and closed chest tubes and medical and fluid interventions were inadequate, necessitating subsequent thoracotomy.Main Results and ConclusionsRight ventricular rupture during resuscitation was found during subsequent thoracotomy. This rupture and inadequacy of closed-chest resuscitation were felt to be associated with the operative pneumonectomy and pericardiotomy. Pathophysiology and the role of open-heart vs. closed-chest resuscitative measures are discussed. (Crit Care Med 1999; 27:1378-1379)
ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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34. |
Sublingual PCO2measurementThe nitroglycerin of monitoring? |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1380-1381
Robert,
Schlichtig Stephen O.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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35. |
Organ apoptosis in the septic patientA potential therapeutic target? |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1381-1382
Lyle L.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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36. |
Factors impeding enteral tube feedings |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1383-1384
Lisa L.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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37. |
The ideal sedation assessment toolAn elusive instrument |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1384-1385
Eric T.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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38. |
Helicobacter pylori and critical illnessA passive bystander or cause of disease? |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1385-1386
Felicity H.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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39. |
Immunoglobulins in anergic patientsChoice of patients, identification of dependent variables, and importance of study |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1387-1388
Nicolas V.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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40. |
Doppler stroke volume measurementIs it coming toward an intensive care unit near you? |
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Critical Care Medicine,
Volume 27,
Issue 7,
1999,
Page 1388-1389
David H.,
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ISSN:0090-3493
出版商:OVID
年代:1999
数据来源: OVID
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