Monitoring and Optimization of Tissue oxygenation In Critically ill patients
Ahmed MohammedMohaseb;
Abstract
The tissue oxygenation and its manipulation has a central role in the management of the critically ill patient.
Monitoring of tissue oxygenation in the critically ill has become a target for therapeutic interventions.A number of noninvasive methods are now available to determine the tissue oxygenation state of the critically ill patients includingglobal markers of tissue oxygenation as lactate and base excess with addition of tools for monitoring gas exchange as pulse oximetry and capnography.The tools used to assess tissue oxygenation have been discussedin details with their predictive value, limitations and clinical utility.
Monitoring of cerebral oxygenation has an important role in management of patients with acute neurological injuries as brain ischemia and hypoxia are central causes of brain damage in these patients. Various neuromonitoring devices are available forassessment oxygenation state of brain tissue including Jugular venous bulb oximetry, transcranial doppler ultrasonography and near-infrared cerebral spectroscopy.
Adequate tissuesoxygenation is one of the cornerstones of intensive care management to prevent MOF.
Understanding the determinants of tissue oxygenation and the cellular consequences of alterations in oxygen supply is mandatory for optimizing patient care.
Oxygen delivery is primarily dependent on the hemoglobin concentration, the arterial oxygenation and the cardiac output. The cardiac output is determined by the combined effects of preload, afterload and contractility. Oxygen delivery can be optimized by blood transfusion, plasma expanders and inotropic agents.
Oxygen consumption in critically ill patient is influenced by many factorsincludingsepsis, fever and agitation. Optimization of oxygen consumption can be achieved by controlling of these factors.A clear understanding of these factors is essential to the practice of critical care medicine.
Furthermore, patients cannot be optimized by simplistic algorithms but rather by thoughtful intensivist, who at the bedside can integrate the complex information to create a course of management based on the best available scientific evidence.
Monitoring of tissue oxygenation in the critically ill has become a target for therapeutic interventions.A number of noninvasive methods are now available to determine the tissue oxygenation state of the critically ill patients includingglobal markers of tissue oxygenation as lactate and base excess with addition of tools for monitoring gas exchange as pulse oximetry and capnography.The tools used to assess tissue oxygenation have been discussedin details with their predictive value, limitations and clinical utility.
Monitoring of cerebral oxygenation has an important role in management of patients with acute neurological injuries as brain ischemia and hypoxia are central causes of brain damage in these patients. Various neuromonitoring devices are available forassessment oxygenation state of brain tissue including Jugular venous bulb oximetry, transcranial doppler ultrasonography and near-infrared cerebral spectroscopy.
Adequate tissuesoxygenation is one of the cornerstones of intensive care management to prevent MOF.
Understanding the determinants of tissue oxygenation and the cellular consequences of alterations in oxygen supply is mandatory for optimizing patient care.
Oxygen delivery is primarily dependent on the hemoglobin concentration, the arterial oxygenation and the cardiac output. The cardiac output is determined by the combined effects of preload, afterload and contractility. Oxygen delivery can be optimized by blood transfusion, plasma expanders and inotropic agents.
Oxygen consumption in critically ill patient is influenced by many factorsincludingsepsis, fever and agitation. Optimization of oxygen consumption can be achieved by controlling of these factors.A clear understanding of these factors is essential to the practice of critical care medicine.
Furthermore, patients cannot be optimized by simplistic algorithms but rather by thoughtful intensivist, who at the bedside can integrate the complex information to create a course of management based on the best available scientific evidence.
Other data
| Title | Monitoring and Optimization of Tissue oxygenation In Critically ill patients | Other Titles | قياس و رفع كفاءة أكسچةالأنسجة في مرضى الحالات الحرجة | Authors | Ahmed MohammedMohaseb | Issue Date | 2015 |
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