Septic Shock

2017 ◽  
Author(s):  
Allison Dalton ◽  
Mark Nunnally
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Venous Pressure ◽  
Pressure Control ◽  
Organ Damage ◽  
Initial Therapy ◽  
Morbidity And Mortality ◽  
Central Venous ◽  
Saturation Pulse ◽  
Cyclical Pattern

Sepsis is a leading cause of morbidity and mortality worldwide. Infectious injury leads to inflammation, which leads to additional injury. This cyclical pattern leads to tissue dysfunction, resulting in hypovolemic and vasodilatory shock, hyperdynamic circulatory shock, mitochondrial dysfunction, cellular apoptosis, and immunosuppression. Septic patients are unable to use oxygen effectively, leading to organ dysfunction. The key to management of sepsis is early recognition and treatment. Prompt administration of appropriate antibiotics (preferably but not necessarily following culture) is vital to avoiding the morbidity and mortality associated with sepsis. Aggressive fluid resuscitation resulting in improved blood flow to tissues is the mainstay of initial therapy for septic shock. Balancing the needs for improved preload against the consequences of excessive intravascular volume is paramount. There are many methods (e.g., central venous pressure, mixed/central venous saturation, pulse pressure variation, ultrasonography) to determine when a septic shock patient may no longer respond to fluids and requires vasoconstrictors or inotropes for blood pressure control. Early recognition of sepsis, treatment with appropriate antibiotics, and limiting end-organ damage have led to decreased in-hospital mortality associated with septic shock. This review contains 5 figures, 5 tables, and 105 references.      Key Words: antibiotic therapy, fluid therapy, resuscitation, sepsis, shock

Septic Shock

2017 ◽  
Author(s):  
Allison Dalton ◽  
Mark Nunnally
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Venous Pressure ◽  
Pressure Control ◽  
Organ Damage ◽  
Initial Therapy ◽  
Morbidity And Mortality ◽  
Central Venous ◽  
Saturation Pulse ◽  
Cyclical Pattern

Sepsis is a leading cause of morbidity and mortality worldwide. Infectious injury leads to inflammation, which leads to additional injury. This cyclical pattern leads to tissue dysfunction, resulting in hypovolemic and vasodilatory shock, hyperdynamic circulatory shock, mitochondrial dysfunction, cellular apoptosis, and immunosuppression. Septic patients are unable to use oxygen effectively, leading to organ dysfunction. The key to management of sepsis is early recognition and treatment. Prompt administration of appropriate antibiotics (preferably but not necessarily following culture) is vital to avoiding the morbidity and mortality associated with sepsis. Aggressive fluid resuscitation resulting in improved blood flow to tissues is the mainstay of initial therapy for septic shock. Balancing the needs for improved preload against the consequences of excessive intravascular volume is paramount. There are many methods (e.g., central venous pressure, mixed/central venous saturation, pulse pressure variation, ultrasonography) to determine when a septic shock patient may no longer respond to fluids and requires vasoconstrictors or inotropes for blood pressure control. Early recognition of sepsis, treatment with appropriate antibiotics, and limiting end-organ damage have led to decreased in-hospital mortality associated with septic shock. This review contains 5 figures, 5 tables, and 105 references. Key Words: antibiotic therapy, fluid therapy, resuscitation, sepsis, shock

scholarly journals Respiratory variation of inferior vena cava diameter and central venous pressure in ventilated and non-ventilated children in fluid refractory septic shock: an observational study

2019 ◽  
Vol 6 (5) ◽  
pp. 1947
Author(s):  
Mohd Kashif Ali ◽  
Eeman Naim
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Spontaneously Breathing ◽  
Ventilated Patients

Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.

scholarly journals Heat-stress-induced changes in central venous pressure do not explain interindividual differences in orthostatic tolerance during heat stress

2011 ◽  
Vol 110 (5) ◽  
pp. 1283-1289 ◽  
Author(s):  
R. Matthew Brothers ◽  
David M. Keller ◽  
Jonathan E. Wingo ◽  
Matthew S. Ganio ◽  
Craig G. Crandall
Keyword(s):  
Blood Pressure ◽  
Heat Stress ◽  
Central Venous Pressure ◽  
Blood Pressure Control ◽  
Lower Body Negative Pressure ◽  
Venous Pressure ◽  
Pressure Control ◽  
Stress Index ◽  
Central Venous ◽  
The Difference

The extent to which heat stress compromises blood pressure control is variable among individuals, with some individuals becoming very intolerant to a hypotensive challenge, such as lower body negative pressure (LBNP) while heat stressed, while others are relatively tolerant. Heat stress itself reduces indexes of ventricular filling pressure, including central venous pressure, which may be reflective of reductions in tolerance in this thermal condition. This study tested the hypothesis that the magnitude of the reduction in central venous pressure in response to heat stress alone is related to the subsequent decrement in LBNP tolerance. In 19 subjects, central hypovolemia was imposed via LBNP to presyncope in both normothermic and heat-stress conditions. Tolerance to LBNP was quantified using a cumulative stress index (CSI), and the difference between normothermic CSI and heat-stress CSI was calculated for each individual. The eight individuals with the greatest CSI difference between normothermic and heat-stress tolerances (LargeDif), and the eight individuals with the smallest CSI difference (SmallDif), were grouped together. By design, the difference in CSI between thermal conditions was greater in the LargeDif group (969 vs. 382 mmHg × min; P < 0.001). Despite this profound difference in the effect of heat stress in decreasing LBNP tolerance between groups, coupled with no difference in the rise in core body temperatures to the heat stress (LargeDif, 1.4 ± 0.1°C vs. SmallDif, 1.4 ± 0.1°C; interaction P = 0.89), the reduction in central venous pressure during heat stress alone was similar between groups (LargeDif: 5.7 ± 1.9 mmHg vs. SmallDif: 5.2 ± 2.0 mmHg; interaction P = 0.85). Contrary to the proposed hypothesis, differences in blood pressure control during LBNP are not related to differences in the magnitude of the heat-stress-induced reductions in central venous pressure.

A central venous pressure goal of 8–12 mm Hg for all patients in septic shock

2007 ◽  
Vol 35 (5) ◽  
pp. 1441 ◽  
Author(s):  
Michael W. Donnino ◽  
Peter Clardy ◽  
Daniel Talmor
Keyword(s):  
Septic Shock ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Central Venous

scholarly journals High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

2021 ◽  
Vol 10 (17) ◽  
pp. 3945
Author(s):  
Fridtjof Schiefenhövel ◽  
Ralf F. Trauzeddel ◽  
Michael Sander ◽  
Matthias Heringlake ◽  
Heinrich V. Groesdonk ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Central Venous ◽  
Icu Mortality ◽  
Roc Curve Analysis ◽  
Hemodynamic Deterioration ◽  
The Impact

Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.

OPTIMAL CENTRAL VENOUS PRESSURE IN FLUID CHALLENGE IN SEVERE SEPSIS AND SEPTIC SHOCK.

2005 ◽  
Vol 33 ◽  
pp. A166
Author(s):  
Bogdan N Dobrin ◽  
Giulia Soldati ◽  
Marc Van Nuffelen ◽  
Jean-Louis Vincent
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Central Venous ◽  
Sepsis And Septic Shock
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