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Ítem Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock(BioMed Central, 2013-12-01) Arango Dávila, César AugustoVenous-to-arterial carbon dioxide difference (Pv-aCO2) may reflect the adequacy of blood flow during shock states. We sought to test whether the development of Pv-aCO2 during the very early phases of resuscitation is related to multi-organ dysfunction and outcomes in a population of septic shock patients resuscitated targeting the usual oxygen-derived and hemodynamic parameters.
Ítem Epidemiology and clinical outcomes of octogenarian patients in an intensive care unit from a developing country(Springer, 2010-09-01) Ospina Tascón, Gustavo AdolfoAround the world, the elderly population is growing faster than the total population, and this difference in growth rates is increasing [1]. In 1950, 1 in every 20 individuals was aged 65 years or older; by the year 2050, this figure is projected to increase to nearly 1 in 6 (Fig. 1) [1]. These population trends represent a looming crisis for healthcare systems around the world, and understanding patterns of care and outcomes for the ageing segment of the population is vital when planning for future healthcare needs in all countries.Ítem Factors predicting re-laparotomy in severe secondary peritonitis(Springer Netherlands, 2010-01-01) Ospina Tascón, Gustavo AdolfoArtículo del doctor Gustavo Adolfo Ospina Tascón, Internista, Intensivista con PhD en Ciencias Biomedicas que ejerce en la Fundación Valle del Lili y profesor de la Universidad Icesi, es uno de los autores del estudio Andromeda Shock, expuesto en la Sesión Hot Topics del Congreso de la Sociedad Europea de Cuidados Intensivos, donde se destacan y se dan a conocer los trabajos mas importantes en el campo de la medicina de cuidados intensivos en el mundo. Entre ellos la estrategia de reanimación en diferentes momentos. Específicamente en el estudio en mención, el médico cirujano Ospina utilizando la técnica de Laparotomia Exploratoria que se practica en el paciente bajo anestesia general, con una incisión en el abdomen examina los órganos en procura de diagnosticar la Peritonitis secundaria severa.Ítem Intermediate Care Units Should Be “Step Down Units” In Septic Patients(Springer, 2010-09-01) Ospina Tascón, Gustavo Adolfo[No contiene resumen]Ítem The persistence of microvascular dysfunction is associated with a worse outcome in patients with severe sepsis(Springer, 2010-09-01) Neves, Ana P.The persistence of microvascular dysfunction is associated with a worse outcome in patients with severe sepsis. Elaborado por Gustavo Adolfo Ospina,Jacques Creteur, Ana P. Neves, Daniel De Backer, Jean Luis Vincent, publicado por SppringerÍtem Microcirculatory alterations are associated with pulmonary dead-space fraction in moderate and severe ards(Springer International Publishing, 2015-10-03) Madriñán, HJShunt-induced hypoxemia i s considered the primary pathophysiological abnormality and main diagnostic cri- teria of acute respiratory distress syndrome (ARDS). However, increases in dead- space ventilation (VD/VT) can also contribute to gas exchange alterations in ARDS. Systemic microcirculatory alterations described during inflammatory conditions are characterized by perfusion heterogeneity and theoretically pulmonary microcirculatory heterogene ity could lead to imbalance pulmonary ventilation/perfusion relationship. Thus, we hypothesized that systemic microvascular alterations could reflect increased VD/VT in ARDS.Ítem Monitoring the microcirculation in the critically ill patient: current methods and future approaches(Springer, 2010-11-01) De Backer, DanielTo discuss the techniques currently available to evaluate the microcirculation in critically ill patients. In addition, the most clinically relevant microcirculatory alterations will be discussed. Review of the literature on methods used to evaluate the microcirculation in humans and on microcirculatory alterations in critically ill patients. In experimental conditions, shock states have been shown to be associated with a decrease in perfused capillary density and an increase in the heterogeneity of microcirculatory perfusion, with non-perfused capillaries in close vicinity to perfused capillaries. Techniques used to evaluate the microcirculation in humans should take into account the heterogeneity of microvascular perfusion. Microvideoscopic techniques, such as orthogonal polarization spectral (OPS) and sidestream dark field (SDF) imaging, directly evaluate microvascular networks covered by a thin epithelium, such as the sublingual microcirculation. Laser Doppler and tissue O(2) measurements satisfactorily detect global decreases in tissue perfusion but not heterogeneity of microvascular perfusion. These techniques, and in particular laser Doppler and near-infrared spectroscopy, may help to evaluate the dynamic response of the microcirculation to a stress test. In patients with severe sepsis and septic shock, the microcirculation is characterized by a decrease in capillary density and in the proportion of perfused capillaries, together with a blunted response to a vascular occlusion test.Ítem Should microcirculation monitoring be used to guide fluid resuscitation in severe sepsis and septic shock?(Associação de Medicina Intensiva Brasileira - AMIB, 2015-04-01) Ospina Tascón, Gustavo AdolfoTissue hypoperfusion and subsequent limited oxygen transport are critical features conducting to organ failure during shock states. Therefore, early identification of tissue hypoperfusion and adequate resuscitation are key for improving the probability of survival after septic shock. (1,2) However, how to identify organ perfusion abnormalities at the bedside and select the type and amount of fluids required to improve tissue hypoxia remain highly controversial. Traditionally, clinical signs, such as reduced blood pressure and urinary output, altered consciousness, and mottled skin, have been used to identify tissue perfusion abnormalities.Ítem Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock(BioMed Central, 2016-08-02) Tapia, Pablo J.Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock. Methods: Eighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experimentsÍtem Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?(Springer Verlag, 2016-02-01) Ospina Tascón, Gustavo AdolfoPurpose Septic shock has been associated with microvascular alterations and these in turn with the development of organ dysfunction. Despite advances in video microscopic techniques, evaluation of microcirculation at the bedside is still limited. Venous-to-arterial carbon dioxide difference (Pv-aCO2) may be increased even when venous O2 saturation (SvO2) and cardiac output look normal, which could suggests microvascular derangements. We sought to evaluate whether Pv-aCO2 can reflect the adequacy of microvascular perfusion during the early stages of resuscitation of septic shock.