Holistic Monitoring and Treatment in Septic Shock
Sepsis-related circulatory dysfunction is usually manifested as an early hypovolemic state that can be reversed with initial fluid resuscitation. If not reversed early, this can progress into a persistent circulatory dysfunction. In contrast to a quite pr
- PDF / 224,799 Bytes
- 10 Pages / 439.37 x 666.142 pts Page_size
- 26 Downloads / 290 Views
Holistic Monitoring and Treatment in Septic Shock Glenn Hernández, Lara Rosenthal, and Jan Bakker
1.1
Introduction
Shock was recently defined, by a taskforce of the European Society of Intensive Care, as a life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells [1]. In this state, the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysfunction. The result is cellular dysoxia, i.e., the loss of the physiological independence between oxygen delivery and oxygen consumption, associated with increased lactate levels [1]. Septic shock would thus represent this syndrome in the presence of an acute infection. In older definitions, much more significance was given to the frequently present clinical symptoms in order to facilitate recognition. In the 1992 consensus definition by an American College of Chest Physicians and Society of Critical Care Medicine consensus conference, both included both volume-refractory hypotension and G. Hernández Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile L. Rosenthal Rosenthal Acupuncture, New York, NY, USA J. Bakker (*) Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands Division of Pulmonary and Critical Care, New York University Langone Medical Center – Bellevue Hospital, New York, NY, USA e-mail: [email protected] © Springer International Publishing AG, part of Springer Nature 2018 A. A. Pinto Lima, E. Silva (eds.), Monitoring Tissue Perfusion in Shock, https://doi.org/10.1007/978-3-319-43130-7_1
3
4
G. Hernández et al.
perfusion abnormalities as obligatory components of a septic shock definition [2]. Over the last decade, an even simpler definition has been used, relying mainly on vasopressor requirements [3]. In this definition, perfusion abnormalities were not required for the diagnosis of septic shock. More recently, the Sepsis-3 conference defined septic shock as the combination of hypotension and hyperlactatemia in a patient with infection [4] while disregarding other markers of circulatory dysfunction such as peripheral perfusion abnormalities that were incorporated in the definition of shock by the European Society Task Force [1]. In the Sepsis-3 definition, increased lactate levels in the absence of hypotension do not classify as septic shock. The purpose of this chapter is to provide a holistic integrative view of perfusion monitoring and treatment based on the pathophysiological definition that includes macrohemodynamic and microcirculatory symptoms and their relation to tissue dysoxia in septic shock [1].
1.2
Holistic View
In the diagnosis of the condition of a critically ill patient, physic
Data Loading...
