Detailing the cardiovascular profile in shock patients

Critical Care : the Official Journal of the Critical Care Forum
Daniel De Backer

Abstract

Evaluation of the cardiovascular profile of critically ill patients is one of the most important actions performed in critically ill patients. It allows recognition that the patient is in shock and characterization of the type of circulatory failure. This step is crucial to initiate supportive interventions and to cure the cause responsible for the development of shock. Evaluation of tissue perfusion allows identification of the patient insufficiently resuscitated and also to trigger therapeutic interventions. Monitoring tissue perfusion can be achieved by lactate, venoarterial gradients in PCO2, and central venous or mixed venous oxygen saturation. Ultimately, monitoring the microcirculation may help not only to identify alterations in tissue perfusion but also to identify the type of alterations: diffuse decrease in microvascular perfusion versus heterogeneity in the alterations, as in sepsis, with well perfused areas in close vicinity to poorly perfused areas. Regarding supportive therapy, a step-by-step approach is suggested, with fluid optimization followed by vasoactive support to preserve perfusion pressure and global and regional blood flows. The different variables should be integrated into decision and management path...Continue Reading

References

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Jul 2, 2002·American Journal of Respiratory and Critical Care Medicine·Daniel De BackerJean-Louis Vincent
Nov 9, 2002·Lancet·Peter E SpronkDurk F Zandstra
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Dec 24, 2003·American Heart Journal·Daniel De BackerJean-Louis Vincent
Mar 12, 2010·Intensive Care Medicine·Gustavo Ospina-TasconDaniel De Backer
Sep 13, 2011·Annals of Intensive Care·Daniel De BackerJean-Louis Vincent
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Mar 19, 2014·The New England Journal of Medicine·Pierre AsfarUNKNOWN SEPSISPAM Investigators
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Jul 15, 2015·Intensive Care Medicine·Maurizio CecconiUNKNOWN ESICM Trial Group
Nov 19, 2015·Intensive Care Medicine·Gustavo A Ospina-TascónDaniel De Backer
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Mar 10, 2016·Intensive Care Medicine·Daniel De Backer, Jean-Louis Vincent
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Jan 24, 2017·JAMA : the Journal of the American Medical Association·Daniel De Backer, Todd Dorman

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Citations

Mar 22, 2018·Current Opinion in Critical Care·Thomas W L ScheerenJean-Louis Teboul
Jul 22, 2018·Heart·Jerrold SpapenVincent Michiels
May 3, 2018·Journal of Travel Medicine·Derek P Evans
Jul 12, 2019·Journal of Clinical Monitoring and Computing·Philippe PortranJean-Luc Fellahi
Aug 29, 2020·The American Journal of Nursing·Nicole W CaldwellChristopher A VanFosson
Apr 5, 2018·Frontiers in Veterinary Science·Jessica Noel-Morgan, William W Muir
Jun 16, 2019·Critical Care : the Official Journal of the Critical Care Forum·Daniel De Backer, Pierre Foulon
Oct 17, 2020·Seminars in Respiratory and Critical Care Medicine·Daniel De Backer, Jean-Louis Vincent

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