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Review
. 2015 Jul-Sep;13(3):441-7.
doi: 10.1590/S1679-45082015RW3148. Epub 2015 Aug 21.

How to choose the therapeutic goals to improve tissue perfusion in septic shock

[Article in English, Portuguese]
Murillo Santucci Cesar de Assuncao  1 , Thiago Domingos Corrêa  1 , Bruno de Arruda Bravim  1 , Eliézer Silva  1
Affiliations
Review

How to choose the therapeutic goals to improve tissue perfusion in septic shock

[Article in English, Portuguese]
Murillo Santucci Cesar de Assuncao et al. Einstein (Sao Paulo). 2015 Jul-Sep.

Abstract
in English, Portuguese

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.

O reconhecimento e o tratamento precoce da sepse grave e do choque séptico é a chave para o sucesso terapêutico. Quanto maior o atraso no início do tratamento, pior é o prognóstico, em decorrência da hipoperfusão tecidual persistente, e do consequente desenvolvimento e agravamento das disfunções orgânicas. Um dos principais mecanismos responsáveis pelo desenvolvimento da disfunção celular é a hipóxia. A adequação do fluxo sanguíneo tecidual e, consequentemente, da oferta de oxigênio à demanda metabólica, de acordo com a avaliação do índice cardíaco e da taxa de extração de oxigênio, deve ser realizada durante a ressuscitação, principalmente nos pacientes de alta complexidade. Novas tecnologias, de fácil manuseio à beira do leito, e novos estudos, que avaliem diretamente o impacto da otimização dos parâmetros macro-hemodinâmicos na microcirculação e no desfecho clínico dos pacientes sépticos, são necessários.

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Figures

Figure 1
Figure 1. Relations between supply, consumption, and oxygen extraction ratio, mixed venous saturation of oxygen, arterial lactate, and gradient of partial carbon dioxide pressure in the gastric mucosa
Figure 2
Figure 2. Behavior of mixed venous saturation of oxygen, according to supply and consumption of oxygen
Figure 3
Figure 3. Goal-guided resuscitation algorithm protocol for patients with septic shock
Figura 1
Figura 1. Relações entre oferta, consumo e taxa de extração de oxigênio, saturação venosa mista de oxigênio, lactato arterial e gradiente de pressão parcial de gás carbônico da mucosa gástrica
Figura 2
Figura 2. Comportamento da saturação venosa mista de oxigênio, de acordo com a oferta e o consumo de oxigênio
Figura 3
Figura 3. Algoritmo de ressuscitação protocolado guiado por metas para pacientes com choque séptico
See this image and copyright information in PMC

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