Hemodynamic and perfusion end points for volemic resuscitation in sepsis.
Sepsis is the systemic inflammatory response syndrome secondary to a local infection, and severe sepsis and septic shock are the more devastating scenarios of this disease. In the last decade, considerable achievements were obtained in sepsis knowledge, and an international campaign was developed to improve the treatment of this condition. However, sepsis is still one of the most important causes of death in intensive care units. The early stages of sepsis are characterized by a variety of hemodynamic derangements that induce a systemic imbalance between tissue oxygen supply and demand, leading to global tissue hypoxia. This dysfunction, which may occur in patients presenting normal vital signs, can be accompanied by a significant increase in both morbidity and mortality. The early identification of high-risk sepsis patients through tissue perfusion markers such as lactate and venous oxygen saturation is crucial for prompt initiation of therapeutic support, which includes early goal-directed therapy as necessary. The purpose of this article was to review the most commonly used hemodynamic and perfusion parameters for hemodynamic optimization in sepsis, emphasizing the physiological background for their use and the studies that demonstrated their effectiveness as goals of volemic resuscitation.
da Silva Ramos
Fernando José
FJ
Intensive Care and Anesthesiology Research Laboratory, Research and Education Institute, Hospital Sírio Líbanês, University of São Paulo School of Medicine, São Paulo, Brazil.
Azevedo
Luciano César Pontes
LC
D000138:Acidosis / Q000188:drug therapy / Q000209:etiology; D000818:Animals; D015415:Biomarkers; D001794:Blood Pressure; D002302:Cardiac Output; D042241:Early Diagnosis; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D007773:Lactates / Q000097:blood; D010100:Oxygen / Q000097:blood; D012151:Resuscitation / Q000379:methods*; D012306:Risk; D018805:Sepsis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D012769:Shock / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014680:Veins
D015415:Biomarkers; D007773:Lactates; D010100:Oxygen