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Holistic Monitoring and Treatment in Septic Shock

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Monitoring Tissue Perfusion in Shock

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Abstract

Sepsis-related circulatory dysfunction is usually manifested as an early hypovolemic state that can be reversed with initial fluid resuscitation. If not reversed early, this can progress into a persistent circulatory dysfunction. In contrast to a quite predictable course during the initial phase, persistent circulatory dysfunction is a complex and heterogeneous syndrome. All individual perfusion parameters have extensive limitations to adequately reflect tissue perfusion status in this phase. However, a multimodal approach integrating observation, macrohemodynamics, metabolic parameters, and peripheral and eventually microcirculatory perfusion parameters can overcome their individual limitations. This proposal may provide a holistic understanding of the predominant underlying mechanisms of hypoperfusion and lead to individualized and physiologically oriented therapeutic strategies.

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Authors and Affiliations

  1. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Glenn Hernández & Jan Bakker

  2. Rosenthal Acupuncture, New York, NY, USA

    Lara Rosenthal

  3. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA

    Jan Bakker

  4. Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands

    Jan Bakker

  5. Division of Pulmonary and Critical Care, New York University Langone Medical Center – Bellevue Hospital, New York, NY, USA

    Jan Bakker

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  1. Glenn Hernández
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  2. Lara Rosenthal
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  3. Jan Bakker
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Correspondence to Jan Bakker .

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Editors and Affiliations

  1. Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands

    Alexandre Augusto Pinto Lima

  2. Medical School Hospital of the Albert Einstein, Sao Paulo, Brazil

    Eliézer Silva

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Hernández, G., Rosenthal, L., Bakker, J. (2018). Holistic Monitoring and Treatment in Septic Shock. In: Pinto Lima, A., Silva, E. (eds) Monitoring Tissue Perfusion in Shock. Springer, Cham. https://doi.org/10.1007/978-3-319-43130-7_1

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  • DOI: https://doi.org/10.1007/978-3-319-43130-7_1

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