Tissue perfusion and oxygenation to monitor fluid responsiveness in critically ill, septic patients after initial resuscitation: a prospective observational study

Verfasser / Beitragende:
[Eva Klijn, Marit van Velzen, Alexandre Lima, Jan Bakker, Jasper van Bommel, A. Groeneveld]
Ort, Verlag, Jahr:
2015
Enthalten in:
Journal of Clinical Monitoring and Computing, 29/6(2015-12-01), 707-712
Format:
Artikel (online)
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024 7 0 |a 10.1007/s10877-014-9653-8  |2 doi 
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245 0 0 |a Tissue perfusion and oxygenation to monitor fluid responsiveness in critically ill, septic patients after initial resuscitation: a prospective observational study  |h [Elektronische Daten]  |c [Eva Klijn, Marit van Velzen, Alexandre Lima, Jan Bakker, Jasper van Bommel, A. Groeneveld] 
520 3 |a Fluid therapy after initial resuscitation in critically ill, septic patients may lead to harmful overloading and should therefore be guided by indicators of an increase in stroke volume (SV), i.e. fluid responsiveness. Our objective was to investigate whether tissue perfusion and oxygenation are able to monitor fluid responsiveness, even after initial resuscitation. Thirty-five critically ill, septic patients underwent infusion of 250mL of colloids, after initial fluid resuscitation. Prior to and after fluid infusion, SV, cardiac output sublingual microcirculatory perfusion (SDF: sidestream dark field imaging) and skin perfusion and oxygenation (laser Doppler flowmetry and reflectance spectroscopy) were measured. Fluid responsiveness was defined by a ≥5 or 10% increase in SV upon fluids. In responders to fluids, SDF-derived microcirculatory and skin perfusion and oxygenation increased, but only the increase in cardiac output, mean arterial and pulse pressure, microvascular flow index and relative Hb concentration and oxygen saturation were able to monitor a SV increase. Our proof of principle study demonstrates that non-invasively assessed tissue perfusion and oxygenation is not inferior to invasive hemodynamic measurements in monitoring fluid responsiveness. However skin reflectance spectroscopy may be more helpful than sublingual SDF. 
540 |a The Author(s), 2015 
690 7 |a Fluid loading  |2 nationallicence 
690 7 |a Microcirculation  |2 nationallicence 
690 7 |a Passive leg raising  |2 nationallicence 
690 7 |a Microvascular oxygenation  |2 nationallicence 
690 7 |a Septic shock  |2 nationallicence 
700 1 |a Klijn  |D Eva  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
700 1 |a van Velzen  |D Marit  |u Departments of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands  |4 aut 
700 1 |a Lima  |D Alexandre  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
700 1 |a Bakker  |D Jan  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
700 1 |a van Bommel  |D Jasper  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
700 1 |a Groeneveld  |D A.  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
773 0 |t Journal of Clinical Monitoring and Computing  |d Springer Netherlands  |g 29/6(2015-12-01), 707-712  |x 1387-1307  |q 29:6<707  |1 2015  |2 29  |o 10877 
856 4 0 |u https://doi.org/10.1007/s10877-014-9653-8  |q text/html  |z Onlinezugriff via DOI 
898 |a BK010053  |b XK010053  |c XK010000 
900 7 |a Metadata rights reserved  |b Springer special CC-BY-NC licence  |2 nationallicence 
908 |D 1  |a research-article  |2 jats 
949 |B NATIONALLICENCE  |F NATIONALLICENCE  |b NL-springer 
950 |B NATIONALLICENCE  |P 856  |E 40  |u https://doi.org/10.1007/s10877-014-9653-8  |q text/html  |z Onlinezugriff via DOI 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Klijn  |D Eva  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a van Velzen  |D Marit  |u Departments of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Lima  |D Alexandre  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Bakker  |D Jan  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a van Bommel  |D Jasper  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Groeneveld  |D A.  |u Departments of Intensive Care, Erasmus MC University Medical Centre, Room H 621, PO box 2040, 3000 CA, Rotterdam, The Netherlands  |4 aut 
950 |B NATIONALLICENCE  |P 773  |E 0-  |t Journal of Clinical Monitoring and Computing  |d Springer Netherlands  |g 29/6(2015-12-01), 707-712  |x 1387-1307  |q 29:6<707  |1 2015  |2 29  |o 10877