A Review article published in Crit_Care discusses the different options regarding personalization of hemodynamic monitoring and management of septic shock patients, at various stages of shock.
, the use of PAC provides an assessment of the adequacy of CO and its determinants. While it does not predict fluid responsiveness, PAC is excellent for assessing fluid effectiveness and tolerance through the fluid challenge. The simultaneous measurement of CVP and pulmonary artery pressure makes PAC ideal for monitoring patients with right heart dysfunction.
Eventually, the choice of monitoring technique should be based on the patient condition, local experience and availability, and anticipated response to therapy. A stepwise approach for the patient in septic shock is suggested .During stabilization and de-escalation, the tools and targets should be adapted. During these phases, the purpose of hemodynamic support changes from optimization of tissue perfusion to prevention of complications while providing organ support.
During the stabilization phase, cardiac dysfunction and resuscitation-induced volume overload are common, and the already implemented hemodynamic tools often continue to be used. Lung ultrasound and the assessment of hepatic, renal, and portal venous flow patterns by ultrasound can identify signs of venous congestion which may indicate the need for volume removal and/or administration of inotropes [].
A frequent complication is the development of right ventricular dysfunction that may develop in 20% of patients with acute respiratory distress syndrome subjected to lung protective ventilatory strategies []. Accordingly, repeating echocardiography at regular intervals may be helpful, especially if CVP is increasing. Managing these patients is challenging and may include the modulation of ventilatory settings and administration of inotropic agents.
During the de-escalation phase, the situation is even more complex. Patients are usually minimally monitored, and indices of tolerance are not well defined. Should we still target the same values as in the optimization phase? Probably not, but it remains unknown how to determine the level of abnormality that may be tolerated. It sounds logical not to go back to shock .
Australia Latest News, Australia Headlines
Similar News:You can also read news stories similar to this one that we have collected from other news sources.
City Council spending £600,000 employing ‘critical’ staffNottingham City Council’s reserves will be spent on hiring a number of new employees to help improve its failing children’s services.
Read more »
Man critical after stabbed multiple times in BelfastA man remains in hospital on Monday night after he was repeatedly stabbed in East Belfast.
Read more »
What’s Changed Since TIME Named the ‘Silence Breakers’ Person of the YearFive years after survivors of workplace harassment and assault were named Person of the Year, many still worry about speaking out
Read more »
Indoor Air Pollution and Impaired Cardiac Autonomic Function in Chronic Obstructive Pulmonary Disease | American Journal of Respiratory and Critical Care Medicine | Articles in Press
Read more »
North Carolina Power Outages Could Last Days After ShootingsFederal, state and local authorities are undertaking a massive investigation of what's being described as an attack on critical infrastructure
Read more »
Girl thanks incredible Leeds hospice staff for 'genuine care' shown when her brother diedInspired by the care her family received and her brother's love of Christmas, Umayyah Haqnawaz has embarked on a fundraising mission for Martin House Children's Trust.
Read more »