(Peripheral) Temperature and microcirculation
|
|
|
- Chloe Melton
- 6 years ago
- Views:
Transcription
1 (Peripheral) Temperature and microcirculation Prof. Jan Bakker MD, PhD Chair dept Intensive Care Adults
2 Intensive Care Med (2005) 31: DOI /s R E V I E W Alexandre Lima Jan Bakker Noninvasive monitoring of peripheral perfusion Clinical assessment Temperature and temperature gradients Ttoe ΔT[Central-Toe], ΔT[Proximal-Distal] Optical monitoring PFI, NIRS, OPS/SDF, LDF Transcutaneous PO2 and PCO2
3 Temperature and perfusion Anesthesiology 1988;68: ;69: : ;83: r=0.98 Forearm-Finger Tgradient ( o C) Perfusion Index (u)
4 Correlates of thenar NIRS derived tissue O2 saturation after cardiac surgery Uilkema et al. Interact Cardiovasc Thorac Surg 2007;6(3): patients 70 yr (46-84) Duration MV 10h (5-48) CABG: 9 CABG+valve: 6 AVR: 5 MVR: 3 rs 0.48, P<0.001
5 Vascular Occlusion Test 1 3 min 30 mm Hg above SAP
6 Peripheral vasoconstriction influences thenar oxygen saturation as measured by NIRS Lima et al. Intensive Care Med 2012 (in press) 8 healthy volunteers (26±6 yr) use of cooling blanket cooling of the periphery without change in core temperature (tympanic temperature) water temperature 32 o C measurements: baseline, 30 after start cooling, 30 after suspension of cooling (rewarmed) StO2 measured with 15 mm probe on thenar muscle CO measured by NICOM (Cheetah) Skin vasoconstriction: 50% decrease in Tskin-diff or PI
7 Peripheral vasoconstriction influences thenar oxygen saturation as measured by NIRS Lima et al. Intensive Care Med 2012 (in press) Baseline Cold 30 Rewarmed 30 HR (b/min) MAP (mmhg) SV (ml) CO (L/min) Core Temp ( o C) 76 [70-83] 67 [58-73] 70 [67-74] 93 [88-101] 100 [92-107] 95 [87-100] 110 [76-125] 139 [ ] 114 [ ] 8,6 [8,0-9,4] 10,1 [8,9-12,2] 7,9 [7,3-10,1] 36,8 [36,6-36,9] 36,6 [36,4-36,9] 36,6 [36,4-36,9] median [IQR]
8 Peripheral vasoconstriction influences thenar oxygen saturation as measured by NIRS Lima et al. Intensive Care Med 2012 (in press) Baseline Cold 30 Rewarmed 30 StO2 (%) RincStO2 (%/sec) Tskin-diff ( o C) CRT (sec) PI (%) 82 [80-87] 72 [70-77] * 80 [79-85] 3,0 [2,8-3,3] 1,7 [1,1-2,0] * 3,2 [3,0-4,2] 1,0 [-1,6-1,8] 3,1 [1,8-4,3] * 1,2 [-0,3-2,7] 2,5 [2,0-3,0] 8,5 [7,2-11,0] * 4,0 [3,0-5,7] 10,0 [9,1-11,7] 2,5 [2,0-3,8] * 9,1 [8,2-11,7] median [IQR]
9 Peripheral vasoconstriction influences thenar oxygen saturation as measured by NIRS Lima et al. Intensive Care Med 2012 (in press)
10 Relation of NIRS with changes in peripheral circulation in critically ill patients Lima et al. Crit Care Med 2011;39: critically ill patients Age: 57 (17-90) SOFA: 6 (1-15) APACHE II: 23 (6-35) Septic shock n=33 Shock without sepsis: n= 25 No shock or sepsis: n=15
11 Relation of NIRS with changes in peripheral circulation in critically ill patients Lima et al. Crit Care Med 2011;39: mixed linear model over 3 days Upslope (%/s) estimate (95% CI) HR b/min (-0.09;0.09) MAP (mmhg) Abnormal Peripheral Circulation (-0.13;0.075) -1.1 (-0.8;-1.4)**
12 Skin temperature and systemic circulation Cool vs. warm skin Similar: Heart rate, blood pressure, PAOP, Hemoglobin, FiO 2, PaO 2, PaCO 2 Cardiac Index Arterial ph SvO 2 Lactate Cool 2.9 ± ± ± ± 1.5 Warm 4.3 ± 1.2 * 7.39 ± 0.07 * 68 ± 8 * 2.2 ± 1.6 * Kaplan et al. J Trauma 2001;50:
13 The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients Alexandre Lima, MD; Tim C. Jansen, MD; Jasper van Bommel, MD, PhD; Can Ince, PhD; Jan Bakker, MD, PhD Table 1. Demographic data of the patients Number of patients 50 Age (yrs) 51 (17 80) Male/female 39/11 Sequential Organ Failure 8 (2 15) Assessment score admission Acute Physiology and Chronic 23 (13 35) Health Evaluation II Admission category Pneumonia 9 Trauma 8 Abdominal sepsis 7 Postoperative 5 Chronic obstructive 3 pulmonary disease Cardiogenic shock 2 Hepatic encephalopathy 2 Hypovolemic/hemorrhagic 2 shock Mediastinitis 2 Meningitis 2 Pancreatitis 2 Postcardiac arrest 2 Cerebrovascular accident 1 Lung cancer 1 Systemic lupus erythematosus 1 Urosepsis 1 Survivor/nonsurvivor 35/15 Objective Parameters Subjective Evaluation Normal (n 27) Abnormal (n 23) T skin-diff ( C) T c-toe ( C) PFI T, forearm-to-fingertip skin-temperature gradient; T, central-to-toe temperature differ- Patients with abnormal peripheral perfusion were more likely to have increased lactate had significantly less decreases in lactate levels had OR 7.4 of increasing organ failure p Values are given as mean (range) whereap- Crit Care Med 2009; 37:
14 Peripheral perfusion cardiogenic shock Odd s ratio for day-30 mortality Oliguria 3.4 ( ) Altered sensorium 2.1 ( ) Cold, clammy skin 1.8 ( ) Gusto I trial: patients Am Heart J 1999;138:21-31
15 Research Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients Alexandre Lima, Jasper van Bommel, Tim C Jansen, Can Ince and Jan Bakker Critical Care 2009, 13(Suppl 5):S13 (doi: /cc8011) Patients with circulatory failure (increased lactate) enrolled in EGDT protocol (8 hours) immediately following admission Table 1 Patient demographic data Number of patients 22 Age (years) 62 (57 to 71) Male/female 16/6 Sequential Organ Failure Assessment score 7 (5 to 9) Acute Physiology and Chronic Health Evaluation II score 23 (16 to 30) Admission category Septic shock Circulatory failure not associated with sepsis Without circulatory failure or sepsis 3 pneumonia, 3 abdominal sepsis, 1 meningitis 3 hypovolemic/hemorrhagic, 3 cardiogenic, 4 postoperative, 2 trauma 1 cerebrovascular accident, 2 postoperative Noradrenaline use 16 (72%) Noradrenaline dose (µg/kg/minute) 0.16 (0.07 to 0.24) Dobutamine use 8 (36%) Dobutamine dose (µg/kg/minute) 4.3 (3.6 to 6.3) Mechanical ventilation 15 (68%) Survivor/nonsurvivor 17/5 Data expressed as number, as median (25th to 75th percentile), or as n (%).
16 n=22 abnormal peripheral perfusion n=14 2 hours normal peripheral perfusion n=8 29% 13% n=8 n=2 8 hours n=6 n=6 50% 50% Mortality 0% 0% StO2 ±60% StO2 ±80%
17 Clinical significance of low StO2 in patients with shock patients with abnormal peripheral circulation following EGDT have more organ failure
18 Dynamics of StO2 mortality StO2 n=221 Admission Evolution during first 24h Normal n=160 Normal (>75%) n=181 Abnormal n=21 Abnormal (<75%) n=40 Abnormal n=25 ICU mortality 15% 57% Normal n=15 13% 56% Odds for mortality: persistent low StO2 during first 24h 7.9 (CI: 3-21, P<0.001) Odds for mortality: when StO2 decreased to <75% during first 24h 7.1 (CI: 2-21, P<0.001) Odds for mortality: persistent low StO2 and low peripheral perfusion 9.9 (CI: 3-41ß, P<0.001)
19 Peripheral and microcirculatory perfusion abnormalities following out-of-hospital cardiac arrest Michel van Genderen et al. Crit Care Med 2012 (in press)
20 Peripheral and microcirculatory perfusion abnormalities following out-of-hospital cardiac arrest Michel van Genderen et al. Crit Care Med 2012 (in press) Conclusions: Following outof-hospital cardiac arrest, the early post-resuscitation phase is characterized by abnormalities in sublingual microcirculation and peripheral tissue perfusion, which are caused by vasoconstriction due to induced systemic hypothermia and not by impaired systemic blood flow. Persistence of these alterations is associated with organ failure and death, independent of systemic hemodynamics.
21 Abnormal peripheral perfusion effect of a stepwise increasing dose of NTG T baseline T max T end Capillary refill time, sec 9 [8-12] 4 * [4-6] 7* [4-10] Perfusion index, % 0.7 [ ] 2.7 * [ ] 1.6 * [ ] Tskin-difference, 0 C 3 [ ] 0.8 * [ ] 1.4 * [ ] StO2 (%) 77 [64-82] 85 * [74-92] 83 [73-88] Values are expressed as median [25th-75th] * P<0.05 vs. TBL1 and TBL2
22 Conclusions Core and peripheral temperature relate to peripheral perfusion by vascular tone Peripheral perfusion is related to peripheral tissue oxygenation and microcirculatory function by vascular tone Abnormal peripheral perfusion is related to decreased lactate clearance increased organ failure and mortality Peripheral perfusion can be improved by NTG Patient outcome after improving peripheral perfusion is unknown
Vasopressors in septic shock
Vasopressors in septic shock Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Questions 1- Why do we use vasopressors in septic shock? 2- Which first-line agent? 3- When
Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy
Intensive Care Med (2012) 38:606 611 DOI 10.1007/s00134-012-2486-3 ORIGINAL Alexandre Lima Michel Egide van Genderen Eva Klijn Jan Bakker Jasper van Bommel Peripheral vasoconstriction influences thenar
Department of Intensive Care, Room HS3.20, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
Research Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients Alexandre Lima, Jasper van Bommel, Tim C Jansen, Can Ince and
EGDT lactate. Prof. Jan Bakker MD, PhD Chair dept Intensive Care Adults. Tuesday, March 20, 12
EGDT lactate Prof. Jan Bakker MD, PhD Chair dept Intensive Care Adults jan.bakker@erasmusmc.nl www.intensivecare.me 100 n=156 Hospital mortality (%) r=0.99 2006-2008 90 80 70 60 50 40 30 20 >3 >4 >5 >6
Are Patients Hypoperfused in the ED? Rapid Perfusion Assessment in the Emergency Department
Are Patients Hypoperfused in the ED? Rapid Perfusion Assessment in the Emergency Department R. Benjamin Saldaña DO, FACEP Associate Medical Director Methodist Emergency Care Center, Houston TX Disclosure
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
The Hemodynamic Puzzle
The Hemodynamic Puzzle SVV NIRS O 2 ER Lactate Energy Metabolism (Oxygen Consumption) (Ml/min/m 2 ) Oxygen Debt: To Pay or Not to Pay? Full Recovery Possible Delayed Repayment of O 2 Debt Oxygen Deficit
Netherlands. 1Dept. of Intensive Care, Erasmus MC, Rotterdam, the Netherlands
Early peripheral perfusion-guided fluid therapy in patients with septic shock Michel E. van Genderen MSc 1, Noel Engels MSc 1, Ralf J. P. van der Valk PhD 2,3, Alexandre Lima MD PhD 1, Eva Klijn MD 1,
Prof. Dr. Iman Riad Mohamed Abdel Aal
The Use of New Ultrasound Indices to Evaluate Volume Status and Fluid Responsiveness in Septic Shock Patients Thesis Submitted for partial fulfillment of MD degree in Anesthesiology, Surgical Intensive
Oximetry. Jan Bakker. Grants Hutchinson Pulsion.
Oximetry Jan Bakker jan.bakker@erasmusmc.nl www.erasmusmc.me Grants Hutchinson Pulsion Postgraduate Workshop on Hemodynamic Monitoring ISICEM 2012 - Brussels Oximetry arterial (pulse oximetry) central/mixed
Management of Post Cardiac Arrest Syndrome
Management of Post Cardiac Arrest Syndrome Wilhelm Behringer Associated Professor of Emergency Medicine Medical University of Vienna, Austria Patients % What happens after ROSC? 35 30 25 20 15 10 5 ROSC
R2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
What is. InSpectra StO 2?
What is InSpectra StO 2? www.htibiomeasurement.com What is InSpectra StO 2? Hemoglobin O 2 saturation is measured in three areas: 1) Arterial (SaO 2, SpO 2 ) Assesses how well oxygen is loading onto hemoglobin
Early Goal-Directed Therapy
Early Goal-Directed Therapy Where do we stand? Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hôpital Cochin & Institut Cochin, Paris-F Resuscitation targets in septic shock 1 The
Effects of mechanical ventilation on organ function. Masterclass ICU nurses
Effects of mechanical ventilation on organ function Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16
Dr. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia (Spain) Pulsion MAB
State of the Art Hemodynamic Monitoring III CO, preload, lung water and ScvO2 The winning combination! Dr. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia
Frank Sebat, MD - June 29, 2006
Types of Shock Hypovolemic Shock Low blood volume decreasing cardiac output. AN INTEGRATED SYSTEM OF CARE FOR PATIENTS AT RISK SHOCK TEAM and RAPID RESPONSE TEAM Septic or Distributive Shock Decrease in
Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough?
Endpoints of Resuscitation for Circulatory Shock: When Enough is Enough? Emanuel P. Rivers, MD, MPH, IOM Vice Chairman and Research Director Departments of Emergency Medicine and Surgery Henry Ford Hospital
Shock - from Diagnostic to Therapeutic Implications
Shock - from Diagnostic to Therapeutic Implications Rui Moreno, MD, PhD, Professor UCINC, Hospital de São José Centro Hospitalar de Lisboa Central, E.P.E. LEARNING OBJECTIVES Review the markers of tissue
Bedside assessment of fluid status
Bedside assessment of fluid status 2nd AKI Academy October 18 th 2014 David Treacher Guy s & St Thomas NHS Trust Assessing the circulation - the 3 key questions v Is my patient adequately filled? v What
Pulse oximetry revisited. Dr Liesel Bösenberg Specialist Physician and Fellow in Critical Care Kalafong Hospital University of Pretoria
Pulse oximetry revisited Dr Liesel Bösenberg Specialist Physician and Fellow in Critical Care Kalafong Hospital University of Pretoria Topics that will be discussed and dissected: Revisiting physiology
Goal-directed resuscitation in sepsis; a case-based approach
Goal-directed resuscitation in sepsis; a case-based approach Jorge A Guzman, MD, FCCM Head, Section Critical Care Medicine Respiratory Institute Cleveland Clinic Foundation The challenges to managing septic
Fluid responsiveness and extravascular lung water
Fluid responsiveness and extravascular lung water Prof. Jean-Louis TEBOUL Medical ICU Bicetre hospital University Paris-South France Conflicts of interest Member of the Medical Advisory Board of Maquet/Pulsion
In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine
In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,
Assessing Patients During Septic Shock Resuscitation
CE 1.5 HOURS Continuing Education Assessing Patients During Septic Shock Resuscitation How to integrate capillary refill time and skin mottling score into the six-hour bundle. ABSTRACT: In 2015, the Surviving
UTILITY of ScvO 2 and LACTATE
UTILITY of ScvO 2 and LACTATE Professor Jeffrey Lipman Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland THIS TRIP SPONSORED AND PAID FOR BY STRUCTURE Physiology -
Contraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley
Contraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley British Journal of Surgery 2013; 100: 1045 1049 The risk of 30 day mortality
Staging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
IV fluid administration in sepsis. Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London
IV fluid administration in sepsis Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London The talk What is septic shock? What are the recommendations? What is the evidence? Do we follow
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures
Sepsis is an important issue. Clinician s decision-making capability. Guideline recommendations
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%
The Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
IABP to prevent pulmonary edema under VA-ECMO
IABP to prevent pulmonary edema under VA-ECMO Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie,
Fluid Resuscitation and Monitoring in Sepsis. Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS
Fluid Resuscitation and Monitoring in Sepsis Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS Learning Objectives Compare and contrast fluid resuscitation strategies in septic shock Discuss available
Rounds in the ICU. Eran Segal, MD Director General ICU Sheba Medical Center
Rounds in the ICU Eran Segal, MD Director General ICU Sheba Medical Center Real Clinical cases (including our mistakes) Emphasis on hemodynamic monitoring Usually no single correct answer We will conduct
Case scenario V AV ECMO. Dr Pranay Oza
Case scenario V AV ECMO Dr Pranay Oza Case Summary 53 y/m, k/c/o MVP with myxomatous mitral valve with severe Mitral regurgitation underwent Mitral valve replacement with mini thoracotomy Pump time nearly
PiCCO based algorithms
European Society of Anaesthesiologists Annual Meeting 12.-15. June 2010, Helsinki, Finland PiCCO based algorithms Berthold Bein, MD, PhD, DEAA Department of Anaesthesiology and Intensive Care Medicine
Evidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
The changing face of
The changing face of sepsis. @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser (maternal sepsis) to WHO Breast cancer Cognitive impairment Mild 3.8 7.1
Pediatric Code Blue. Goals of Resuscitation. Focus Conference November Ensure organ perfusion
Pediatric Code Blue Focus Conference November 2015 Duane C. Williams, MD Pediatric Critical Care Department of Pediatrics Children s Hospital of Richmond at VCU Goals of Resuscitation Ensure organ perfusion
SEPSIS: Seeing Through the. W. Graham Carlos MD, MSCR, ATSF, FACP
SEPSIS: Seeing Through the W. Graham Carlos MD, MSCR, ATSF, FACP Objectives Forget everything you have known about sepsis Learn new things Objectives Define sepsis Explain why Early Goal Directed Therapy
Failure of the circulation to maintain Tissue cellular. Tissue hypoperfusion Cellular hypoxia SHOCK. Perfusion
Shock SHOCK Failure of the circulation to maintain Tissue cellular Perfusion Organs Syndrome RR
EARLY GOAL DIRECTED THERAPY : seminaires iris. Etat des lieux en Daniel De Backer
EARLY GOAL DIRECTED THERAPY : Etat des lieux en 2017 Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles Past-President European
Post-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena
Post-Resuscitation Care Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Conflict of interest Emcools Shareholder and founder, honoraria Zoll: honoraria Bard: honoraria, nephew works
Presented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
Early-goal-directed therapy and protocolised treatment in septic shock
CAT reviews Early-goal-directed therapy and protocolised treatment in septic shock Journal of the Intensive Care Society 2015, Vol. 16(2) 164 168! The Intensive Care Society 2014 Reprints and permissions:
Nothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
Updates in Sepsis 2017
Mortality Cases Total U.S. Population/1,000 Updates in 2017 Joshua Solomon, M.D. Associate Professor of Medicine National Jewish Health University of Colorado Denver Background New Definition of New Trials
9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
How to maintain optimal perfusion during Cardiopulmonary By-pass. Herdono Poernomo, MD
How to maintain optimal perfusion during Cardiopulmonary By-pass Herdono Poernomo, MD Cardiopulmonary By-pass Target Physiologic condition as a healthy person Everything is in Normal Limit How to maintain
SHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
This PDF is available for free download from a site hosted by Medknow Publications
Indian J Crit Care Med Oct-Dec 006 Vol 10 Issue 4 IJCCM October-December 003 Vol 7 Issue 4 Research Article Correlation of mixed venous and central venous oxygen saturation and its relation to cardiac
Objectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
IDENTIFYING SEPSIS IN THE PREHOSPITAL SETTING
IDENTIFYING SEPSIS IN THE PREHOSPITAL SETTING Christopher Hunter, MD, PhD, FACEP Director, Health Services Department Associate Medical Director, Orange County EMS System Medical Director, Orlando Health
4/5/2018. Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY. I have no financial disclosures
Update on Sepsis NIKHIL JAGAN PULMONARY AND CRITICAL CARE CREIGHTON UNIVERSITY I have no financial disclosures 1 Objectives Why do we care about sepsis Understanding the core measures by Centers for Medicare
A holistic approach for perfusion assessment in septic shock: Basic foundations and clinical applications Hernández Poblete, Glenn
UvA-DARE (Digital Academic Repository) A holistic approach for perfusion assessment in septic shock: Basic foundations and clinical applications Hernández Poblete, Glenn Link to publication Citation for
Sepsis and Shock States
Sepsis and Shock States Presented By: Cynthia Webner BSN, RN, CCRN, CMC www.cardionursing.com CNEA 2009 1 INFECTION Inflammatory response to microorganisms, or Invasion of normally sterile tissues SYSTEMIC
Shock. Shao Mian Emergency Department,Zhongshan Hospital
Shock Shao Mian Emergency Department,Zhongshan Hospital What is shock THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890 1925 THE MODERN ERA: BLALOCK S EPIPHANY POSTMODERNISM:
Sepsis. From EMS to ER to ICU. What we need to be doing
Sepsis From EMS to ER to ICU What we need to be doing NEHAL BHATT, MD ATHENS PULMONARY, CRITICAL CARE AND SLEEP Objectives 1. Define the changes to the definition of Sepsis 2. Describe the assessment,
DO 2 > VO 2. The amount of oxygen delivered is a product of cardiac output (L/min) and the amount of oxygen in the arterial blood (ml/dl).
Shock (Part 1): Review and Diagnostic Approach Jeffrey M. Todd, DVM, DACVECC University of Minnesota, St. Paul, MN Overview Shock is the clinical presentation of inadequate oxygen utilization, typically
Shock and hemodynamic monitorization. Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital
Shock and hemodynamic monitorization Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital Shock Leading cause of morbidity and mortality Worldwide: dehydration and hypovolemic
PREVENT COMPLICATIONS IN MAJOR SURGERY
PREVENT COMPLICATIONS IN MAJOR SURGERY Dept of Anesthesia and ICM (Prof. G. Della Rocca) Azienda Ospedaliero-Universitaria University of Udine. Udine, Italy CLINICAL TRIAL OF SURVIVORS CARDIORESPIRATORY
CASE SERIES IN POSTOPERATIVE CARDIAC SURGERY PATIENTS
2 nd International User Meeting October 2, 2015 Berlin Prof. Dr. Karl Träger Cardiosurgical ICU Dept. of Cardiac Anesthesiology University Hospital Ulm Albert-Einstein-Allee 23, 89081 Ulm GERMANY karl.traeger@uniklinik-ulm.de
AllinaHealthSystem 1
: Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support
ECMO for Refractory Septic Shock Prof. Alain Combes
ECMO for Refractory Septic Shock Prof. Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie, Paris
Sepsis and septic shock Practical hemodynamic consequences. Intensive Care Training Program Radboud University Medical Centre Nijmegen
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
Acute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
Radboud University Nijmegen Medical Centre Why measure cardiac output in critically ill children?
Radboud University Nijmegen Medical Centre Why measure cardiac output in critically ill children? J. Lemson Anesthesiologist/(pediatric)intensivist Case; Girl 2 years, 12 kg, severe meningococcal septic
ECMO: a breakthrough in care for respiratory failure. PD Dr. Thomas Müller Regensburg no conflict of interest
ECMO: a breakthrough in care for respiratory failure? PD Dr. Thomas Müller Regensburg no conflict of interest 1 Overview Mortality of severe ARDS Indication for ECMO PaO 2 /FiO 2 Efficiency of ECMO: gas
Sepsis overview. Dr. Tsang Hin Hung MBBS FHKCP FRCP
Sepsis overview Dr. Tsang Hin Hung MBBS FHKCP FRCP Epidemiology Sepsis, severe sepsis, septic shock Pathophysiology of sepsis Recent researches and advances From bench to bedside Sepsis bundle Severe sepsis
Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium
Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium MARIA E. MANDICH MD Fairbanks Memorial Hospital Emergency Department Attending Physician Interior Region EMS Council Medical Director
Didier Payen, MD, Ph D DAR Lariboisière Université Paris 7 Unité INSERM 1160
Assessing response to therapy: SvO 2, lactate, PCO 2 gap, others Didier Payen, MD, Ph D DAR Lariboisière Université Paris 7 Unité INSERM 1160 dpayen1234@orange.fr How can we see the question? Some useful
ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis
Appendix with supplementary material. This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Supplementary Tables Table S1. Definitions
Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock
Lima et al. Critical Care 2014, 18:R126 RESEARCH Open Access Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock Alexandre Lima *, Michel E van
SHOCK Susanna Hilda Hutajulu, MD, PhD
SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock
NIV in hypoxemic patients
NIV in hypoxemic patients Massimo Antonelli, MD Dept. of Intensive Care & Anesthesiology Università Cattolica del Sacro Cuore Rome - Italy Conflict of interest (research grants and consultations): Maquet
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Jon Rittenberger, MD, MS Department of University of Pittsburgh Employers: Disclosures - Rittenberger University of Pittsburgh UPMC
How can the PiCCO improve protocolized care?
How can the PiCCO improve protocolized care? Azriel Perel Professor and Chairman Department of Anesthesiology and Intensive Care Sheba Medical Center, Tel Aviv University, Israel ESICM, Vienna 2009 Disclosure
Goal-directed vs Flow-guidedresponsive
Goal-directed vs Flow-guidedresponsive therapy S Magder Department of Critical Care, McGill University Health Centre Flow-directed vs goal directed strategy for management of hemodynamics S Magder Curr
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
Admissions with severe sepsis in adult, general critical care units in England, Wales and Northern Ireland
Admissions with severe sepsis in adult, general critical care units in England, Wales and Northern Ireland Question For all admissions to adult, general critical care units in the Case Mix Programme Database
Monitoring the microcirculation to guide resuscitation
Monitoring the microcirculation to guide resuscitation Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles President European
Fluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity
NIV in Acute Respiratory Failure: Where we fail? Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Use of NIV 1998-2010 50 45 40 35 30 25 20 15 10 5 0 1998
Use of Blood Lactate Measurements in the Critical Care Setting
Use of Blood Lactate Measurements in the Critical Care Setting John G Toffaletti, PhD Director of Blood Gas and Clinical Pediatric Labs Professor of Pathology Duke University Medical Center Chief, VAMC
Introduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained
INDUCED HYPOTHERMIA. F. Ben Housel, M.D.
INDUCED HYPOTHERMIA F. Ben Housel, M.D. Historical Use of Induced Hypothermia 1950 s - Moderate hypothermia (30-32º C) in open heart surgery to protect brain against global ischemia 1960-1980 s - Use of
Noninvasive monitoring of peripheral perfusion
Intensive Care Med (2005) 31:1316 1326 DOI 10.1007/s00134-005-2790-2 R E V I E W Alexandre Lima Jan Bakker Noninvasive monitoring of peripheral perfusion Received: 21 February 2005 Accepted: 4 August 2005
Sepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
The Case for Multivessel Revascularization in Shock
The Case for Multivessel Revascularization in Shock Emmanouil S. Brilakis, MD, PhD Minneapolis Heart Institute 9.37 9.49 am Disclosures Consulting/speaker honoraria: Abbott Vascular, American Heart Association
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
Diagnosis and Management of Sepsis and Septic Shock. Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire
Diagnosis and Management of Sepsis and Septic Shock Martin D. Black MD Concord Pulmonary Medicine Concord, New Hampshire Financial: none Disclosures Objectives: Identify physiologic principles of septic
Case year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50
Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with
Sepsis and septic shock
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
Making vasopressors safer
Making vasopressors safer Requirements for safe vaspressor use In an ideal world 1. Knowledge of what constitutes optimal vasopressor dosing 2. A culture of cautiousness regarding vasopressors What do
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic
Post Cardiac Arrest Care. From : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Post Cardiac Arrest Care From : 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Initial Objectives of Post cardiac Arrest Care Optimize cardiopulmonary
Sepsis Awareness and Education
Sepsis Awareness and Education Meets the updated New York State Department of Health (NYSDOH) requirements for Infection Control and Barrier Precautions coursework Element VII: Sepsis Awareness and Education
Brain under pressure Impact of vasopressors
Brain under pressure Impact of vasopressors Brain dysfunction in sepsis Incidence: - Varying nomenclature: sepsis-associated encephalopathy, delirium, brain dysfunction - Consistently recognized as frequent: