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2 results

  • 22 - Optimizing Hemodynamic Therapy by Monitoring Microcirculation: One Step Forward in Matching Tissue Oxygen Delivery to Consumption

  • from Section 4 - Future Directions
    • By
  • Edited by Alexandre Joosten, University of California, Los Angeles, Maxime Cannesson, University of California, Los Angeles, Robert G. Hahn, Karolinska Institutet, Stockholm
  • Book:
    Hemodynamic Monitoring and Fluid Therapy during Surgery
    Published online:
    11 April 2024
    Print publication:
    02 May 2024, pp 257-266

  • Summary

    Restoring the microcirculation and tissue oxygenation is the ultimate goal of hemodynamic resuscitation. Hand-held vital microscopes enable direct visualization of the sublingual microcirculation of RBC flow through the capillaries and the density of perfused capillaries. The association between alterations of sublingual microvascular parameters and patient outcomes during shock validates that these parameters are clinically relevant for the assessment of patients in shock. Assessment of sublingual microvascular perfusion parameters at the bedside is only conceivable if hand-held vital microscopes are easy to use and if the analysis of the images can be done in real time. Studies have shown that real-time point-of-care assessment by visual inspection of microcirculatory properties at the bedside shows good agreement with off-line evaluation of the microcirculation. The development of automatic microcirculatory analysis software systems will be the next step to obtain high-performance quantitative analysis at the patient’s bedside and for caregivers to adhere to this monitoring technique. Lastly, the impact of sublingual microcirculation on patient outcome remains to be proven during the perioperative setting.

  • Chapter 18 - Principles of antibiotics use

  • from Section II: - Systemic disorders and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 124-129

  • Summary

    The failure of cardiovascular system to maintain adequate organ perfusion pressure causes inadequate oxygen delivery resulting in tissue hypoxia, lactic acidosis and end organ damage. Inotropes affect the force of myocardial contraction. A positive inotrope will increase myocardial contractility. Vasopressors cause vasoconstriction of blood vessels (most act by α1 receptor activation) and therefore increase mean arterial blood pressure (MAP) and systemic vascular resistance (SVR). Vasoactive drugs are used to support tissue perfusion and hence oxygenation. Vasoactive drugs act on various receptors in the body to produce their effects. Treatment with vasoactive drugs should be considered, if optimization of oxygenation, ventilation and adequate fluid resuscitation fail to restore cardiac output. Therapy may need to be started with minute-by-minute assessment of the patient's response. The response to vasoactive drugs is often unpredictable and dependent on the cause of shock and baseline circulation.