title: How to choose the therapeutic goals to improve tissue perfusion in septic shock.
abstract: The early recognition and treatment of severe sepsis and septic shock is the key to a successful outcome. The longer the delay in starting treatment, the worse the prognosis due to persistent tissue hypoperfusion and consequent development and worsening of organ dysfunction. One of the main mechanisms responsible for the development of cellular dysfunction is tissue hypoxia. The adjustments necessary for adequate tissue blood flow and therefore of oxygen supply to metabolic demand according to the assessment of the cardiac index and oxygen extraction rate should be performed during resuscitation period, especially in high complexity patients. New technologies, easily handled at the bedside, and new studies that directly assess the impact of macro-hemodynamic parameter optimization on microcirculation and in the clinical outcome of septic patients, are needed.
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Murillo Santucci Cesar de
authors: MS
authors: Assuncao
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Thiago Domingos
authors: TD
authors: Corrêa
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Bruno de Arruda
authors: Bde A
authors: Bravim
authors: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors: Eliézer
authors: E
authors: Silva
mesh_terms: D003422:Critical Care; D042241:Early Diagnosis; D006439:Hemodynamics; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008833:Microcirculation / Q000502:physiology; D010100:Oxygen / Q000378:metabolism; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*
chemical_list: D019344:Lactic Acid; D010100:Oxygen