Hypoxia-related parameters during septic shock resuscitation: Pathophysiological determinants and potential clinical implications.
Hypoxia
capillary refill time
lactate
septic shock
Journal
Annals of translational medicine
ISSN: 2305-5839
Titre abrégé: Ann Transl Med
Pays: China
ID NLM: 101617978
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
entrez:
11
7
2020
pubmed:
11
7
2020
medline:
11
7
2020
Statut:
ppublish
Résumé
Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio (LPR) and the ratio between veno-arterial PCO Secondary analysis of a randomized controlled trial. Septic shock patients were randomized to fluid resuscitation directed to normalization of capillary refill time (CRT) versus normalization or significant lowering of lactate. Multimodal assessment of perfusion was performed at 0, 2, 6 and 24 hours, and included macrohemodynamic and metabolic perfusion variables, CRT, regional flow and hypoxia markers. Patients who attained their pre-specified endpoint at 2-hours were compared to those who did not. Forty-two patients were recruited, median APACHE-II score was 23 [15-31] and 28-day mortality 23%. LPR and ΔPCO Hypoxia markers did not exhibit correlation during resuscitation in septic shock patients. They probably interrogate different pathophysiological processes and mechanisms of dysoxia during early septic shock. Future studies should better elucidate the interaction and clinical role of hypoxia markers during septic shock resuscitation.
Sections du résumé
BACKGROUND
BACKGROUND
Assessment of tissue hypoxia at the bedside has yet to be translated into daily clinical practice in septic shock patients. Perfusion markers are surrogates of deeper physiological phenomena. Lactate-to-pyruvate ratio (LPR) and the ratio between veno-arterial PCO
METHODS
METHODS
Secondary analysis of a randomized controlled trial. Septic shock patients were randomized to fluid resuscitation directed to normalization of capillary refill time (CRT) versus normalization or significant lowering of lactate. Multimodal assessment of perfusion was performed at 0, 2, 6 and 24 hours, and included macrohemodynamic and metabolic perfusion variables, CRT, regional flow and hypoxia markers. Patients who attained their pre-specified endpoint at 2-hours were compared to those who did not.
RESULTS
RESULTS
Forty-two patients were recruited, median APACHE-II score was 23 [15-31] and 28-day mortality 23%. LPR and ΔPCO
CONCLUSIONS
CONCLUSIONS
Hypoxia markers did not exhibit correlation during resuscitation in septic shock patients. They probably interrogate different pathophysiological processes and mechanisms of dysoxia during early septic shock. Future studies should better elucidate the interaction and clinical role of hypoxia markers during septic shock resuscitation.
Identifiants
pubmed: 32647709
doi: 10.21037/atm-20-2048
pii: atm-08-12-784
pmc: PMC7333100
doi:
Types de publication
Journal Article
Langues
eng
Pagination
784Informations de copyright
2020 Annals of Translational Medicine. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-2048). The series “Hemodynamic monitoring in critically ill patients” was commissioned by the editorial office without any funding or sponsorship. GH served as the unpaid Guest Editor of the series. The other authors have no other conflicts of interest to declare.
Références
J Crit Care. 2018 Dec;48:443-444
pubmed: 30293671
Ann Intensive Care. 2016 Dec;6(1):10
pubmed: 26842697
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Am J Respir Crit Care Med. 1996 Nov;154(5):1573-8
pubmed: 8912783
Crit Care Med. 2011 Jul;39(7):1649-54
pubmed: 21685739
Am J Respir Crit Care Med. 2020 Feb 15;201(4):423-429
pubmed: 31574228
Chest. 1992 Oct;102(4):1124-7
pubmed: 1395755
Intensive Care Med. 2002 Mar;28(3):272-7
pubmed: 11904655
JAMA. 2019 Feb 19;321(7):654-664
pubmed: 30772908
Curr Opin Crit Care. 2018 Jun;24(3):190-195
pubmed: 29634494
Med Intensiva. 2008 Apr;32(3):134-42
pubmed: 18381018
Curr Opin Crit Care. 2006 Aug;12(4):315-21
pubmed: 16810041
Crit Care Med. 2000 Jan;28(1):114-9
pubmed: 10667509
Intensive Care Med. 2007 Nov;33(11):1967-71
pubmed: 17661014
Intensive Care Med. 2015 May;41(5):796-805
pubmed: 25792204
PLoS One. 2017 Nov 27;12(11):e0188548
pubmed: 29176794
Intensive Care Med. 2013 Aug;39(8):1435-43
pubmed: 23740284
J Crit Care. 2016 Oct;35:105-9
pubmed: 27481743
Circulation. 1970 Jun;41(6):989-1001
pubmed: 5482913
Intensive Care Med. 2019 Jan;45(1):82-85
pubmed: 29754310
Shock. 2000 Jul;14(1):8-12
pubmed: 10909886
Science. 1964 Mar 27;143(3613):1457-9
pubmed: 14107454
J Thorac Dis. 2019 Jul;11(Suppl 11):S1528-S1537
pubmed: 31388457
Lancet. 2018 Jul 7;392(10141):75-87
pubmed: 29937192
Intensive Care Med. 2016 Nov;42(11):1801-1804
pubmed: 26873834
Rev Bras Ter Intensiva. 2018 Jul-Sept;30(3):253-263
pubmed: 30066731
Crit Care. 2020 Jan 23;24(1):23
pubmed: 31973735
Crit Care Med. 2013 Jun;41(6):1412-20
pubmed: 23442986
Curr Opin Crit Care. 2018 Jun;24(3):181-189
pubmed: 29561287
J Crit Care. 2012 Jun;27(3):283-8
pubmed: 21798706
Ann Intensive Care. 2012 Oct 15;2(1):44
pubmed: 23067578
Ann Intensive Care. 2018 Apr 23;8(1):52
pubmed: 29687277
Intensive Care Med. 2015 May;41(5):936-8
pubmed: 25851389
Anaesth Intensive Care. 2012 May;40(3):427-32
pubmed: 22577907
Ann Intensive Care. 2017 Dec;7(1):65
pubmed: 28608134
Respir Care. 2014 Oct;59(10):1590-6
pubmed: 25161296
Crit Care Med. 2017 Mar;45(3):486-552
pubmed: 28098591