Oxygen extraction and perfusion markers in severe sepsis and septic shock: diagnostic, therapeutic and outcome implications

Current Opinion in Critical Care
Emanuel P RiversMargaret Disselkamp

Abstract

The purpose of this study is to review the recent literature examining the clinical utility of markers of systemic oxygen extraction and perfusion in the diagnosis, treatment and prognosis of severe sepsis and septic shock. When sepsis is accompanied by conditions in which systemic oxygen delivery does not meet tissue oxygen demands, tissue hypoperfusion begins. Tissue hypoperfusion leads to oxygen debt, cellular injury, organ dysfunction and death. Tissue hypoperfusion can be characterized using markers of tissue perfusion (central venous oxygen saturation and lactate), which reflect the interaction between systemic oxygen delivery and demands. For the last two decades, studies and quality initiatives incorporating the early detection and interruption of tissue hypoperfusion have been shown to improve mortality and altered sepsis care. Three recent trials, while confirming an all-time improvement in sepsis mortality, challenged the concept that rapid normalization of markers of perfusion confers outcome benefit. By defining and comparing haemodynamic phenotypes using markers of tissue perfusion, we may better understand which patients are more likely to benefit from early goal-directed haemodynamic optimization. The phenotypic...Continue Reading

References

Jul 24, 1991·JAMA : the Journal of the American Medical Association·E C Rackow, M E Astiz
Jun 1, 1985·Journal of Applied Physiology·S N HussainC Roussos
Mar 1, 1985·International Journal of Cardiology·J E Parrillo
Jan 1, 1995·American Journal of Respiratory and Critical Care Medicine·C A ManthousL D Wood
Apr 16, 1998·Intensive Care Medicine·G FriedmanJ L Vincent
Apr 18, 2000·Critical Care Clinics·A KumarJ E Parrillo
Jan 17, 2002·The New England Journal of Medicine·E RiversUNKNOWN Early Goal-Directed Therapy Collaborative Group
Oct 11, 2005·Critical Care Medicine·Mitchell M LevyMark D Williams
Jan 11, 2007·Critical Care : the Official Journal of the Critical Care Forum·Hendrik BrachtStephan M Jakob
Jun 23, 2007·Critical Care : the Official Journal of the Critical Care Forum·Jonathan E SevranskyPeter Pronovost
Mar 6, 2008·Critical Care : the Official Journal of the Critical Care Forum·Paul A van BeestMichael A Kuiper
Apr 22, 2008·Critical Care : the Official Journal of the Critical Care Forum·Rinaldo BellomoStephen J Warrillow
Dec 19, 2008·Critical Care : the Official Journal of the Critical Care Forum·Tim C JansenJan Bakker
Feb 25, 2009·Intensive Care Medicine·Michael R MarchickAlan E Jones
Mar 28, 2009·Critical Care Medicine·Mark E MikkelsenJason D Christie
May 6, 2009·Critical Care : the Official Journal of the Critical Care Forum·Glenn HernandezAlejandro Bruhn
Sep 9, 2009·Acta Anaesthesiologica Scandinavica·A PernerA Delaney
Oct 27, 2009·Annals of Emergency Medicine·Jennifer V PopeUNKNOWN Emergency Medicine Shock Research Network (EMShockNet) Investigators
Nov 4, 2009·Critical Care Medicine·Colin K GrissomUNKNOWN National Institutes of Health/National Heart, Lung and Blood Institute Acute Respiratory Distress
Feb 25, 2010·JAMA : the Journal of the American Medical Association·Alan E JonesUNKNOWN Emergency Medicine Shock Research Network (EMShockNet) Investigators
Mar 20, 2010·Critical Care : the Official Journal of the Critical Care Forum·Benoit ValletGilles Lebuffe
Jul 15, 2011·Resuscitation·Michael A PuskarichUNKNOWN Emergency Medicine Shock Research Network (EMSHOCKNET)
Dec 24, 2011·Chest·Gordon E CarrUNKNOWN American Heart Association's Get With the Guidelines-Resuscitation (National Registry of CPR) Investigators
Mar 24, 2012·Journal of Critical Care·Andrea Freyer DugasMichael W Donnino
Aug 15, 2012·Critical Care Medicine·Thiago D CorrêaStephan M Jakob
Feb 21, 2014·Revista Brasileira de terapia intensiva·Otavio Tavares RanzaniUNKNOWN Grupo de Cuidados Críticos Amil
Mar 19, 2014·The New England Journal of Medicine·Donald M YealyDerek C Angus
Mar 29, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Michael R FilbinNathan I Shapiro
Apr 25, 2014·Critical Care : the Official Journal of the Critical Care Forum·Daniel R Ouellette, Sadia Z Shah
Jul 1, 2014·Shock·Sung Yeon HwangYeon Kwon Jeong
Oct 2, 2014·The New England Journal of Medicine·Lars B HolstUNKNOWN Scandinavian Critical Care Trials Group
Oct 2, 2014·The New England Journal of Medicine·Sandra L PeakePatricia Williams
Dec 4, 2014·Journal of Critical Care·Daniel O Thomas-RueddelUNKNOWN Medical Education for Sepsis Source Control and Antibiotics Study Group

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Citations

Mar 19, 2016·Evidence-based Complementary and Alternative Medicine : ECAM·Xiao-Jin LiGong Cheng
Jul 2, 2016·Critical Care : the Official Journal of the Critical Care Forum·H Bryant NguyenEmanuel P Rivers
Jan 19, 2017·Critical Care Medicine·Angel Coz YatacoEmanuel Phillip Rivers
Dec 3, 2016·Emergency Medicine Clinics of North America·John C Greenwood, Clinton J Orloski
Sep 2, 2016·Current Opinion in Critical Care·Matthew GoodwinEmanuel P Rivers
Apr 16, 2019·Artificial Cells, Nanomedicine, and Biotechnology·Lei KuangTao Li
Dec 12, 2020·Transfusion clinique et biologique : journal de la Société française de transfusion sanguine·L C NicolescuC Balta

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