Lactate and microcirculation as suitable targets for hemodynamic optimization in resuscitation of circulatory shock
| Autor: | Michael Kiyatkin, Jan Bakker |
|---|---|
| Přispěvatelé: | Intensive Care |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Resuscitation Lactic acid blood Myocardial Infarction Hemodynamics Critical Care and Intensive Care Medicine Microcirculation 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Lactic Acid Acute circulatory failure business.industry Shock 030208 emergency & critical care medicine 030228 respiratory system Shock (circulatory) Circulatory system Cardiology Hyperlactemia Fluid Therapy medicine.symptom business |
| Zdroj: | Current Opinion in Critical Care, 23(4), 348-354. Lippincott Williams & Wilkins |
| ISSN: | 1531-7072 1070-5295 |
| DOI: | 10.1097/mcc.0000000000000423 |
| Popis: | A discussion of recent research exploring the feasibility of perfusion-guided resuscitation of acute circulatory failure with a focus on lactate and microcirculation.Upon diagnosis of shock, hyperlactemia is associated with poor outcome and, under appropriate clinical circumstances, may reflect inadequate tissue perfusion. Persistent hyperlactemia despite resuscitation is even more strongly correlated with morbidity and mortality. Importantly, there is minimal coherence between lactate trends and static hemodynamic measures such as blood pressure, especially after the initial, hypovolemic phase of shock. During this early period, lactate guided-resuscitation is effective and possibly superior to hemodynamic-guided resuscitation. Similar to hyperlactemia, impaired microcirculation is ubiquitous in shock and is evident even in the setting of hemodynamic compensation (i.e., occult shock). Moreover, persistent microcirculatory derangement is associated with poor outcome and may reflect ongoing shock and/or long-lasting damage. Although the wait continues for a microcirculation-guided resuscitation trial, there is progress toward this goal.Although questions remain, a multimodal perfusion-based approach to resuscitation is emerging with lactate and microcirculation as core measures. In this model, hyperlactemia and microcirculatory derangement support the diagnosis of shock, may help guide resuscitation during the initial period, and may reflect resuscitation efficacy and iatrogenic harm (e.g., fluid overload). |
| Databáze: | OpenAIRE |
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