Daniel De Backer

..Sublingual capnometry could represent a simple, non-invasive method to monitor these microcirculatory alterations in septic patients...

..001). Conclusion:  Ultrasound-guided PNB improved the efficacy of the block compared with the LBT in terms of the postoperative pain during the first postoperative hour and the time to the first requirement for postoperative analgesia...

..We investigated which factors may influence microcirculatory alterations in patients with severe sepsis and whether these are independently associated with mortality...

..Finally, various inotropic agents can counteract septic myocardial depression. So far, no study supports their routine use, but these may be justified on an individual basis...

..Hypertonic solutions may represent an interesting option in some groups of patients but more research is needed in this field...

..These different devices have provided important data helping us to better understand the pathophysiology of sepsis and multiple organ failure...

..Here, we present an alternative interpretation...

..Papers were grouped into the following categories: cardiovascular therapies, biomarkers, hemodynamic monitoring, cardiovascular diseases, and microcirculation...

..The objective was to evaluate the effects of norepinephrine and dopamine on outcome and adverse events in patients with septic shock...

..The place of epinephrine is not well defined, this agent is associated with tachycardia, increased incidence of arrhythmic events, and undesired metabolic effects...

..Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided...

..Heterogeneity in microvascular perfusion is associated with impaired tissue oxygenation. We hypothesized that cardiac surgery with or without cardiopulmonary bypass (CPB) could induce microvascular alterations...

..We hypothesized that microvascular blood flow alterations are present in patients with severe heart failure and cardiogenic shock...

..In conclusion, microcirculatory alterations may play an important role in the development of sepsis-related organ dysfunction. At this stage, therapies to target microcirculation specifically are still being investigated...

..Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option...

..The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion...

..In this issue, a trial investigates the value of pulse pressure variation to predict fluid responsiveness in a large series of patients with ARDS ventilated according to current guidelines...

..To evaluate the influence of tidal volume on the capacity of pulse pressure variation (DeltaPP) to predict fluid responsiveness...

..To discuss the role of microcirculatory abnormalities in critically ill patients and the link between systemic hemodynamics and microvascular perfusion...

..In this editorial, the author discuss the factors influencing the leak and hence its predictive value...

..The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low...

..Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other...

..To discuss the techniques currently available to evaluate the microcirculation in critically ill patients. In addition, the most clinically relevant microcirculatory alterations will be discussed...

..This commentary discusses some of the technical issues related to this test...

..To assess the effects of different doses of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in patients with septic shock...

..The interpretation of blood lactate levels is difficult. Nevertheless, monitoring blood lactate levels can be useful to detect tissue hypoxia and to monitor the effects of therapy...

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..The topical application of acetylcholine totally reversed these alterations. In conclusion, microvascular blood flow alterations are frequent in patients with sepsis and are more severe in patients with a worse outcome...

..This paper reports the results of a round table conference that was organized in Amsterdam in November 2006 in order to achieve consensus on image acquisition and analysis...

..The recommendations formulated by the experts were validated by the working group with the purpose of harmonising FFP transfusion in Belgian hospitals...

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..Stroke volume variations can be useful to detect fluid responsiveness in mechanically ventilated patients...

..Microvascular blood flow alterations are frequently observed in patients with sepsis and can have major pathophysiological implications...

..In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival...

..4 [46.6-64.9] vs. 79.3 [67.2-83.2]%; p =.02). CONCLUSIONS: Microcirculatory alterations improve rapidly in septic shock survivors but not in patients dying with multiple organ failure, regardless of whether shock has resolved...

..Combination of this selective iNOS inhibitor with NE allowed a higher arterial pressure and renal blood flow to be maintained...

..To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion...

..The effects of red blood cell transfusions on microvascular perfusion are not well defined. We investigated the effects of red blood cell transfusion on sublingual microvascular perfusion in patients with sepsis...

..We studied whether tetrahydrobiopterin administration exerts beneficial effects in an ovine septic shock model...

..The optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock...

..However, in clinical practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes in CI after fluid challenge in patients with septic shock...

..We studied whether these recommendations met optimal pharmacokinetic criteria for broad-spectrum antibiotic levels in septic shock patients undergoing CRRT...

..55). CONCLUSIONS: The administration of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock. These changes are independent of changes in systemic hemodynamic variables...

..To evaluate the effects of fluid administration on microcirculatory alterations in sepsis...

..The primary aim of this study was to determine whether 25 mg/kg (total body weight) of amikacin is an adequate loading dose for these patients...

..The objective of this study was to develop a model to identify patients in whom drotrecogin alfa (activated) (DAA) might be administered for periods shorter than the recommended 96 hours...

..To quantify sepsis-induced alterations in changes in muscle tissue oxygenation (StO(2)) after an ischemic challenge using near-infrared spectroscopy (NIRS), and to test the hypothesis that these alterations are related to outcome...

..In endotoxic shock, GLP is increased, but the liver can metabolize this additional load of lactate, so that the hepatosplanchnic area is not a major source of lactate unless the liver becomes profoundly hypoxic...

..The aim of this study was to assess the effects of increasing MAP using norepinephrine (NE) on hemodynamic and metabolic variables and on microvascular reactivity in patients with septic shock...

..A high CL(Cr) was the variable most strongly associated with insufficient drug concentrations...

..CONCLUSIONS: Despite its strong vasopressor effects vasopressin infusion did not worsen microcirculatory alterations in this patient with distributive shock following cardiac surgery...

..We investigated microvascular density and reactivity in the early phase following cardiac arrest...

..The therapeutic benefit of high-dose aminoglycoside therapy should be balanced with its potential renal effects in septic patients receiving CRRT...

..The combination of dobutamine with norepinephrine was associated with a better myocardial performance, greater Do(2) and [OV0312]o(2), lower blood lactate concentration and Pco(2) gap, and less anatomic injury...

..To characterize the hemodynamic course of cardiogenic shock and to relate the cause of death to ongoing cardiac failure or multiple organ dysfunction...

..In this text, we will return to the basic physiology of cardiac output and its components so that we can better understand the effects of cardiovascular alterations in critically ill patients, and how best to treat them...

..Cerebral microcirculatory alterations may play a role; however, experimental data are scarce. This study sought to investigate whether the cerebral microcirculation is altered in a clinically relevant animal model of septic shock...

..In this article, several key factors influencing the systemic and regional efficacy of blood transfusion will be reviewed...

..To determine the effects of fluid challenge on systemic hemodynamic variables and gastric intramucosal partial pressure of carbon dioxide (PCO(2)) in septic patients...

..To evaluate the effects of hydrocortisone on microcirculatory blood flow alterations in patients with septic shock...

..The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements...

..CONCLUSIONS: IPM is safe and reliable and provides valuable information after urgent laparotomy. Persistently high L/P values should raise the possibility of serious postoperative complications...

..760 [571-1077] kcal, p = .05). CONCLUSIONS: Albumin administration may improve organ function in hypoalbuminemic critically ill patients. It results in a less positive fluid balance and a better tolerance to enteral feeding...

..Whether monitoring the microcirculation can be used to guide therapy remains unclear and requires further study, and this is an exciting field of ongoing research...

..This study was designed to evaluate the degree of microcirculatory abnormalities in patients with severe influenza A (H1N1) infection...

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..Excessive use of adrenergic agents may result in stunned myocardium...

..CONCLUSIONS: DAA administration rapidly improves sepsis-induced microvascular alterations, whereas its cessation is associated with a transient deterioration...

..While intensive early resuscitation remains the cornerstone of management, new approaches are beginning to form part of sepsis management protocols and will lead to improved outcomes for patients with this disease process...

..Patients with low IgG concentrations may represent a logical target group to study the effects of Ig supplementation in septic shock...

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..To determine possible differences in morbidity and mortality between early and late onset of septic shock in ICU patients...

..Surgical stimulation may enhance memory formation. The authors' hypothesis is that implicit memory processing is not preserved during unconsciousness, even in the presence of a surgical stimulus...

..1% and the percent of correct classification 72.4%. CONCLUSIONS: A gas leak around the endotracheal tube greater than 15.5% can be used as a screening test to limit the risk of re-intubation for laryngeal edema...

..05). Hence, in this model of septic shock, the administration of a large bolus of sodium selenite (rather than a continuous administration) resulted in beneficial effects, probably by a transient oxidative effect...

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..The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion...

..Therefore, the adequacy of PRD-guided thoracic epidural infusion during general anesthesia for thoracotomy was studied...

..This prospective, randomized, double-blind study evaluated the influence of aprotinin on various blood markers of inflammation during and after cardiopulmonary bypass...

..Further large multi-centre clinical investigations are still required...

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..The quality of care, clinical, scientific and personal, offered by the Department of Intensive Care at Erasme Hospital has earned it the high level reputation for which it is renowned in Belgium, and indeed worldwide...

..Observational studies have provided conflicting results regarding the effects of these two drugs on outcomes, and results from a recently completed randomized controlled trial are eagerly waited...

..In this review we will discuss the epidemiology of ARF within the limitations imposed by comparing studies that use different definitions and focus on different patient populations...

..Treatment using the PMX cartridge is safe and may improve cardiac and renal dysfunction due to sepsis or septic shock. Further studies are needed to prove this effectiveness...

..This article discusses the evidence for and against a key role for disseminated intravascular coagulation in the pathogenesis of multiple organ failure...

..The aim of our study was to determine whether the first dose of piperacillin-tazobactam, ceftazidime, cefepime, and meropenem would result in adequate serum drug concentrations in patients with severe sepsis and septic shock...

..In this study we investigated the effects of colloids or crystalloids on PONV when given in addition to a background minimal crystalloid infusion in a female population of surgical patients...

..CONCLUSIONS: Splanchnic lactate release is uncommon in septic patients, even when hyperlactatemia is severe...

..The histological lesions seen in the control group were unaffected by dobutamine. In conclusion, dobutamine increases liver blood flow and metabolism, but does not affect microscopic findings in this hyperdynamic endotoxic shock model...

..The microcirculatory effects of various therapeutic interventions have still to be reported. OPS technique may become a valuable tool to monitor patients with circulatory failure...