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Published in: Critical Care 3/2006

01-06-2006 | Review

Hemodynamic optimization of sepsis-induced tissue hypoperfusion

Authors: Sergio L Zanotti Cavazzoni, R Phillip Dellinger

Published in: Critical Care | Special Issue 3/2006

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Abstract

Sepsis is associated with cardiovascular changes that may lead to development of tissue hypoperfusion. Early recognition of sepsis and tissue hypoperfusion is critical to implement appropriate hemodynamic support and prevent irreversible organ damage. End points for resuscitation need to be defined and invasive hemodynamic monitoring is usually required. Targets for hemodynamic optimization should include intravascular volume, blood pressure, and cardiac output. Therapeutic interventions aimed at optimizing hemodynamics in patients with sepsis include aggressive fluid resuscitation, the use of vasopressor agents, inotropic agents and in selected cases transfusions of blood products. This review will cover the most important aspects of hemodynamic optimization for treatment of sepsis induced tissue-hypoperfusion.
Literature
1.
go back to reference Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002CrossRefPubMed Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002CrossRefPubMed
2.
go back to reference Dellinger RP: Cardiovascular management of septic shock. Crit Care Med 2003, 31: 946-955. 10.1097/01.CCM.0000057403.73299.A6CrossRefPubMed Dellinger RP: Cardiovascular management of septic shock. Crit Care Med 2003, 31: 946-955. 10.1097/01.CCM.0000057403.73299.A6CrossRefPubMed
3.
go back to reference Sessler CN, Perry JC, Varney KL: Management of severe sepsis and septic shock. Curr Opin Crit Care 2004, 10: 354-363. 10.1097/01.ccx.0000139363.76068.7bCrossRefPubMed Sessler CN, Perry JC, Varney KL: Management of severe sepsis and septic shock. Curr Opin Crit Care 2004, 10: 354-363. 10.1097/01.ccx.0000139363.76068.7bCrossRefPubMed
4.
5.
go back to reference Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med 2003, 348: 138-150. 10.1056/NEJMra021333CrossRefPubMed Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med 2003, 348: 138-150. 10.1056/NEJMra021333CrossRefPubMed
6.
go back to reference Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP: Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990, 113: 227-242.CrossRefPubMed Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP: Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990, 113: 227-242.CrossRefPubMed
7.
go back to reference Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed
8.
go back to reference Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3BCrossRefPubMed Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3BCrossRefPubMed
9.
go back to reference Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, et al.: Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004, 32: 1928-1948. 10.1097/01.CCM.0000139761.05492.D6CrossRefPubMed Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, et al.: Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004, 32: 1928-1948. 10.1097/01.CCM.0000139761.05492.D6CrossRefPubMed
10.
go back to reference Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL: Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000, 162: 134-138.CrossRefPubMed Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL: Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000, 162: 134-138.CrossRefPubMed
11.
go back to reference Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000CrossRefPubMed Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000CrossRefPubMed
12.
go back to reference LeDoux D, Astiz ME, Carpati CM, Rackow EC: Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 2000, 28: 2729-2732. 10.1097/00003246-200008000-00007CrossRefPubMed LeDoux D, Astiz ME, Carpati CM, Rackow EC: Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 2000, 28: 2729-2732. 10.1097/00003246-200008000-00007CrossRefPubMed
13.
go back to reference Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, et al.: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858-873. 10.1097/01.CCM.0000117317.18092.E4CrossRefPubMed Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, et al.: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858-873. 10.1097/01.CCM.0000117317.18092.E4CrossRefPubMed
14.
go back to reference Dellinger RP, Carlet JM, Gerlach H, Ramsey G, Levy M: The surviving sepsis guidelines: not another 'groundhog day'. Crit Care Med 2004, 32: 1601-1602. 10.1097/01.CCM.0000130996.14896.F6CrossRefPubMed Dellinger RP, Carlet JM, Gerlach H, Ramsey G, Levy M: The surviving sepsis guidelines: not another 'groundhog day'. Crit Care Med 2004, 32: 1601-1602. 10.1097/01.CCM.0000130996.14896.F6CrossRefPubMed
16.
go back to reference Choi PT, Yip G, Quinonez LG, Cook DJ: Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999, 27: 200-210. 10.1097/00003246-199901000-00053CrossRefPubMed Choi PT, Yip G, Quinonez LG, Cook DJ: Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999, 27: 200-210. 10.1097/00003246-199901000-00053CrossRefPubMed
17.
go back to reference Cook D, Guyatt G: Colloid use for fluid resuscitation: evidence and spin. Ann Intern Med 2001, 135: 205-208.CrossRefPubMed Cook D, Guyatt G: Colloid use for fluid resuscitation: evidence and spin. Ann Intern Med 2001, 135: 205-208.CrossRefPubMed
18.
go back to reference Schierhout G, Roberts I: Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ 1998, 316: 961-964.PubMedCentralCrossRefPubMed Schierhout G, Roberts I: Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ 1998, 316: 961-964.PubMedCentralCrossRefPubMed
19.
go back to reference Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D: Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 1983, 11: 839-850. 10.1097/00003246-198311000-00001CrossRefPubMed Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D: Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 1983, 11: 839-850. 10.1097/00003246-198311000-00001CrossRefPubMed
20.
go back to reference Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, SAFE Study Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004, 350: 2247-2256. 10.1056/NEJMoa040232CrossRefPubMed Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, SAFE Study Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004, 350: 2247-2256. 10.1056/NEJMoa040232CrossRefPubMed
21.
go back to reference Bordin JO, Heddle NM, Blajchman MA: Biologic effects of leukocytes present in transfused cellular blood products. Blood 1994, 84: 1703-1721.PubMed Bordin JO, Heddle NM, Blajchman MA: Biologic effects of leukocytes present in transfused cellular blood products. Blood 1994, 84: 1703-1721.PubMed
22.
go back to reference Marik PE, Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993, 269: 3024-3029. 10.1001/jama.269.23.3024CrossRefPubMed Marik PE, Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993, 269: 3024-3029. 10.1001/jama.269.23.3024CrossRefPubMed
23.
go back to reference Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed
24.
go back to reference De Backer D, Creteur J, Silva E, Vincent JL: Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 2003, 31: 1659-1667. 10.1097/01.CCM.0000063045.77339.B6CrossRefPubMed De Backer D, Creteur J, Silva E, Vincent JL: Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 2003, 31: 1659-1667. 10.1097/01.CCM.0000063045.77339.B6CrossRefPubMed
25.
go back to reference Marik PE, Mohedin M: The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA 1994, 272: 1354-1357. 10.1001/jama.272.17.1354CrossRefPubMed Marik PE, Mohedin M: The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA 1994, 272: 1354-1357. 10.1001/jama.272.17.1354CrossRefPubMed
26.
go back to reference Meier-Hellmann A, Bredle DL, Specht M, Spies C, Hannemann L, Reinhart K: The effects of low-dose dopamine on splanchnic blood flow and oxygen uptake in patients with septic shock. Intensive Care Med 1997, 23: 31-37. 10.1007/s001340050287CrossRefPubMed Meier-Hellmann A, Bredle DL, Specht M, Spies C, Hannemann L, Reinhart K: The effects of low-dose dopamine on splanchnic blood flow and oxygen uptake in patients with septic shock. Intensive Care Med 1997, 23: 31-37. 10.1007/s001340050287CrossRefPubMed
27.
go back to reference Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J: Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000, 356: 2139-2143. 10.1016/S0140-6736(00)03495-4CrossRefPubMed Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J: Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000, 356: 2139-2143. 10.1016/S0140-6736(00)03495-4CrossRefPubMed
28.
go back to reference Kellum JA, Decker MJ: Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 2001, 29: 1526-1531. 10.1097/00003246-200108000-00005CrossRefPubMed Kellum JA, Decker MJ: Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 2001, 29: 1526-1531. 10.1097/00003246-200108000-00005CrossRefPubMed
29.
go back to reference Leone M, Garnier F, Bourgoin A, Antonini F, Martin C: Renal effects of norepinephrine in septic and nonseptic patients. Chest 2004, 126: 534-539. 10.1378/chest.126.2.534CrossRefPubMed Leone M, Garnier F, Bourgoin A, Antonini F, Martin C: Renal effects of norepinephrine in septic and nonseptic patients. Chest 2004, 126: 534-539. 10.1378/chest.126.2.534CrossRefPubMed
30.
go back to reference Bellomo R, Kellum JA, Wisniewski SR, Pinsky MR: Effects of norepinephrine on the renal vasculature in normal and endotoxemic dogs. Am J Respir Crit Care Med 1999, 159: 1186-1192.CrossRefPubMed Bellomo R, Kellum JA, Wisniewski SR, Pinsky MR: Effects of norepinephrine on the renal vasculature in normal and endotoxemic dogs. Am J Respir Crit Care Med 1999, 159: 1186-1192.CrossRefPubMed
31.
go back to reference Martin C, Papazian L, Perrin G, Saux P, Gouin F: Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993, 103: 1826-1831.CrossRefPubMed Martin C, Papazian L, Perrin G, Saux P, Gouin F: Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993, 103: 1826-1831.CrossRefPubMed
32.
go back to reference Martin C, Viviand X, Leone M, Thirion X: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000, 28: 2758-2765. 10.1097/00003246-200008000-00012CrossRefPubMed Martin C, Viviand X, Leone M, Thirion X: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000, 28: 2758-2765. 10.1097/00003246-200008000-00012CrossRefPubMed
33.
go back to reference Holmes CL, Patel BM, Russell JA, Walley KR: Physiology of vasopressin relevant to management of septic shock. Chest 2001, 120: 989-1002. 10.1378/chest.120.3.989CrossRefPubMed Holmes CL, Patel BM, Russell JA, Walley KR: Physiology of vasopressin relevant to management of septic shock. Chest 2001, 120: 989-1002. 10.1378/chest.120.3.989CrossRefPubMed
34.
go back to reference Landry DW, Levin HR, Gallant EM, Ashton RC Jr, Seo S, D'Alessandro D, Oz MC, Oliver JA: Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 1997, 95: 1122-1125.CrossRefPubMed Landry DW, Levin HR, Gallant EM, Ashton RC Jr, Seo S, D'Alessandro D, Oz MC, Oliver JA: Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 1997, 95: 1122-1125.CrossRefPubMed
35.
go back to reference Landry DW, Oliver JA: The pathogenesis of vasodilatory shock. N Engl J Med 2001, 345: 588-595. 10.1056/NEJMra002709CrossRefPubMed Landry DW, Oliver JA: The pathogenesis of vasodilatory shock. N Engl J Med 2001, 345: 588-595. 10.1056/NEJMra002709CrossRefPubMed
36.
go back to reference Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D: Circulating vasopressin levels in septic shock. Crit Care Med 2003, 31: 1752-1758. 10.1097/01.CCM.0000063046.82359.4ACrossRefPubMed Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D: Circulating vasopressin levels in septic shock. Crit Care Med 2003, 31: 1752-1758. 10.1097/01.CCM.0000063046.82359.4ACrossRefPubMed
37.
go back to reference Tsuneyoshi I, Yamada H, Kakihana Y, Nakamura M, Nakano Y, Boyle WA III: Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit Care Med 2001, 29: 487-493. 10.1097/00003246-200103000-00004CrossRefPubMed Tsuneyoshi I, Yamada H, Kakihana Y, Nakamura M, Nakano Y, Boyle WA III: Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit Care Med 2001, 29: 487-493. 10.1097/00003246-200103000-00004CrossRefPubMed
38.
go back to reference Malay MB, Ashton RC Jr, Landry DW, Townsend RN: Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 1999, 47: 699-703. discussion 703–705CrossRefPubMed Malay MB, Ashton RC Jr, Landry DW, Townsend RN: Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 1999, 47: 699-703. discussion 703–705CrossRefPubMed
39.
go back to reference Patel BM, Chittock DR, Russell JA, Walley KR: Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002, 96: 576-582. 10.1097/00000542-200203000-00011CrossRefPubMed Patel BM, Chittock DR, Russell JA, Walley KR: Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002, 96: 576-582. 10.1097/00000542-200203000-00011CrossRefPubMed
40.
go back to reference van Haren FM, Rozendaal FW, van der Hoeven JG: The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock. Chest 2003, 124: 2256-2260. 10.1378/chest.124.6.2256CrossRefPubMed van Haren FM, Rozendaal FW, van der Hoeven JG: The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock. Chest 2003, 124: 2256-2260. 10.1378/chest.124.6.2256CrossRefPubMed
41.
go back to reference Klinzing S, Simon M, Reinhart K, Bredle DL, Meier-Hellmann A: High-dose vasopressin is not superior to norepinephrine in septic shock. Crit Care Med 2003, 31: 2646-2650. 10.1097/01.CCM.0000094260.05266.F4CrossRefPubMed Klinzing S, Simon M, Reinhart K, Bredle DL, Meier-Hellmann A: High-dose vasopressin is not superior to norepinephrine in septic shock. Crit Care Med 2003, 31: 2646-2650. 10.1097/01.CCM.0000094260.05266.F4CrossRefPubMed
42.
go back to reference Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, et al.: Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004, 32: 21-30. 10.1097/01.CCM.0000105581.01815.C6CrossRefPubMed Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, et al.: Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004, 32: 21-30. 10.1097/01.CCM.0000105581.01815.C6CrossRefPubMed
43.
go back to reference Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parrillo JE: Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984, 100: 483-490.CrossRefPubMed Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parrillo JE: Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 1984, 100: 483-490.CrossRefPubMed
44.
go back to reference Vincent JL, Gris P, Coffernils M, Leon M, Pinsky M, Reuse C, Kahn RJ: Myocardial depression characterizes the fatal course of septic shock. Surgery 1992, 111: 660-667.PubMed Vincent JL, Gris P, Coffernils M, Leon M, Pinsky M, Reuse C, Kahn RJ: Myocardial depression characterizes the fatal course of septic shock. Surgery 1992, 111: 660-667.PubMed
45.
go back to reference Jardin F, Sportiche M, Bazin M, Bourokba A, Margairaz A: Dobutamine: a hemodynamic evaluation in human septic shock. Crit Care Med 1981, 9: 329-332. 10.1097/00003246-198104000-00010CrossRefPubMed Jardin F, Sportiche M, Bazin M, Bourokba A, Margairaz A: Dobutamine: a hemodynamic evaluation in human septic shock. Crit Care Med 1981, 9: 329-332. 10.1097/00003246-198104000-00010CrossRefPubMed
46.
go back to reference Tell B, Majerus TC, Flancbaum L: Dobutamine in elderly septic shock patients refractory to dopamine. Intensive Care Med 1987, 13: 14-18. 10.1007/BF00263550CrossRefPubMed Tell B, Majerus TC, Flancbaum L: Dobutamine in elderly septic shock patients refractory to dopamine. Intensive Care Med 1987, 13: 14-18. 10.1007/BF00263550CrossRefPubMed
47.
go back to reference Vincent JL, Roman A, Kahn RJ: Dobutamine administration in septic shock: addition to a standard protocol. Crit Care Med 1990, 18: 689-693. 10.1097/00003246-199007000-00001CrossRefPubMed Vincent JL, Roman A, Kahn RJ: Dobutamine administration in septic shock: addition to a standard protocol. Crit Care Med 1990, 18: 689-693. 10.1097/00003246-199007000-00001CrossRefPubMed
48.
go back to reference Colardyn FC, Vandenbogaerde JF, Vogelaers DP, Verbeke JH: Use of dopexamine hydrochloride in patients with septic shock. Crit Care Med 1989, 17: 999-1003. 10.1097/00003246-198910000-00007CrossRefPubMed Colardyn FC, Vandenbogaerde JF, Vogelaers DP, Verbeke JH: Use of dopexamine hydrochloride in patients with septic shock. Crit Care Med 1989, 17: 999-1003. 10.1097/00003246-198910000-00007CrossRefPubMed
49.
go back to reference Hannemann L, Reinhart K, Meier-Hellmann A, Wallenfang G, Bredle DL: Dopexamine hydrochloride in septic shock. Chest 1996, 109: 756-760.CrossRefPubMed Hannemann L, Reinhart K, Meier-Hellmann A, Wallenfang G, Bredle DL: Dopexamine hydrochloride in septic shock. Chest 1996, 109: 756-760.CrossRefPubMed
50.
go back to reference Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988, 94: 1176-1186.CrossRefPubMed Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988, 94: 1176-1186.CrossRefPubMed
51.
go back to reference Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed
Metadata
Title
Hemodynamic optimization of sepsis-induced tissue hypoperfusion
Authors
Sergio L Zanotti Cavazzoni
R Phillip Dellinger
Publication date
01-06-2006
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 3/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4829

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