MONITORING AND OPTIMIZATION OF TISSUE OXYGENATION IN CRITICALLY ILL PATIENTS
Reda Ramadan Abd Elbakey;
Abstract
Despite improvements in resuscitation and supportive care, progressive organ dysfunction occurs in a large proportion of patients with acute, life threatening illness. It has been proposed that the multi-organ dysfunction syndrome (MODS) of the critically ill is a consequence of tissue dysoxia attributable to inadequate oxygen delivery, often exacerbated by a microcirculatory injury and increased tissue metabolic demands (distributive hypoxia) (Ince & Sinaasappel, 1999).
This may be further compounded by cytopathic hypoxia attributable to mitochondrial dysfunction (Fink, 2002).
So, Maintenance of tissue perfusion is critical, because global tissue hypoxia is a key step toward multiple organ failure (Rivers et al., 2001).
Emerging data suggest that early aggressive resuscitation of critically ill patients may limit and/or reverse tissue dysoxia and progression to organ failure and improve outcome. Hemodynamic monitoring is essential to resuscitation efforts based on attaining specified targets (Dellinger et al., 2008).
When resuscitation goals for CVP and MAP have been achieved, additional measurements of venous oxygenation and lactate may reveal inadequate tissue oxygenation indicating that additional resuscitation efforts are required (Rady et al., 1996).
Both invasive and noninvasive monitoring tools have been used in critically ill patients in an attempt to optimize resuscitation. Most of these technologies focus on ‘‘upstream’’ markers of resuscitation and provide information on cardiac output and fluid responsiveness (Marik & Baram, 2007).
In this respect, the pulmonary artery catheter (PAC) was regarded as the gold standard, as it provides an accurate estimate of the cardiac output and can be used to determine fluid Responsiveness (Ganz et al., 1971).
However, the role of invasive hemodynamic monitoring in critically ill patients is controversial as the PAC has not been proven to improve patient outcome. Furthermore, the PAC does not provide enough information about the adequacy of tissue oxygenation, i.e., ‘‘downstream’’ markers (Marik & Baram, 2007).
Alternatively, it has been argued that measurements of oxygenation at the level of specific tissues offer more sensitive information (Ward et al., 2001).
Therefore, measurements of tissue perfusion and oxygenation are necessary to determine whether the ultimate goal of resuscitation, and adequate oxygen supply to tissues, has been attained (Ahrens, 2006).
Aim of the Work
This may be further compounded by cytopathic hypoxia attributable to mitochondrial dysfunction (Fink, 2002).
So, Maintenance of tissue perfusion is critical, because global tissue hypoxia is a key step toward multiple organ failure (Rivers et al., 2001).
Emerging data suggest that early aggressive resuscitation of critically ill patients may limit and/or reverse tissue dysoxia and progression to organ failure and improve outcome. Hemodynamic monitoring is essential to resuscitation efforts based on attaining specified targets (Dellinger et al., 2008).
When resuscitation goals for CVP and MAP have been achieved, additional measurements of venous oxygenation and lactate may reveal inadequate tissue oxygenation indicating that additional resuscitation efforts are required (Rady et al., 1996).
Both invasive and noninvasive monitoring tools have been used in critically ill patients in an attempt to optimize resuscitation. Most of these technologies focus on ‘‘upstream’’ markers of resuscitation and provide information on cardiac output and fluid responsiveness (Marik & Baram, 2007).
In this respect, the pulmonary artery catheter (PAC) was regarded as the gold standard, as it provides an accurate estimate of the cardiac output and can be used to determine fluid Responsiveness (Ganz et al., 1971).
However, the role of invasive hemodynamic monitoring in critically ill patients is controversial as the PAC has not been proven to improve patient outcome. Furthermore, the PAC does not provide enough information about the adequacy of tissue oxygenation, i.e., ‘‘downstream’’ markers (Marik & Baram, 2007).
Alternatively, it has been argued that measurements of oxygenation at the level of specific tissues offer more sensitive information (Ward et al., 2001).
Therefore, measurements of tissue perfusion and oxygenation are necessary to determine whether the ultimate goal of resuscitation, and adequate oxygen supply to tissues, has been attained (Ahrens, 2006).
Aim of the Work
Other data
| Title | MONITORING AND OPTIMIZATION OF TISSUE OXYGENATION IN CRITICALLY ILL PATIENTS | Other Titles | رصد وتحقيق بث الأكسجين للأنسجة بالطريقـــة المثــلـى فـى مرضى الحـــالات الحرجـــة | Authors | Reda Ramadan Abd Elbakey | Issue Date | 2014 |
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