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Ítem Establecimiento de un sistema de registro de circulación intravital en órganos de Eleutherodactylus Johnstonei(Universidad Icesi, 2015-01-01) Calderón Cadena , Diana Paola; Castaño Valencia, Rafael Santiago; Asesor TesisLa microscopía intravital permite registrar la dinámica de la sangre y la actividad endotelial asociada a cambios en arteriolas, vaso y vénulas que irrigan tejidos en órganos vivos. Existen equipos como el Sidestream Dark Field Imaging (SDF) que permite realizar ese tipo de registros, de los cuales se puede obtener información para estudios diagnósticos de patologías y de la efectividad de los tratamientos que se estén aplicando. Teniendo en cuenta la importancia de realizar este tipo de observaciones, durante el desarrollo de este proyecto se estableció un sistema de campo oscuro capaz de obtener resultados visuales similares a los que proporciona el SDF.
Ítem Effects of fluids on microvascular perfusion in patients with severe sepsis(Springer-Verlag, 2010-06-01) Donadello, KatiaPurpose To evaluate the effects of fluid administration on microcirculatory alterations in sepsis. Methods With a Sidestream Dark Field device, we evaluated the effects of fluids on the sublingual microcirculation in 60 patients with severe sepsis. These patients were investigated either within 24 h (early, n = 37) or more than 48 h (late, n = 23) after a diagnosis of severe sepsis. Hemodynamic and microcirculatory measurements were obtained before and 30 min after administration of 1,000 ml Ringer’s lactate (n = 29) or 400 ml 4% albumin (n = 31) solutions.Ítem The Endothelium in Sepsis(Lippincott Williams & Wilkins, 2016-03-01) Ince, CanSepsis affects practically all aspects of endothelial cell (EC) function and is thought to be the key factor in the progression from sepsis to organ failure. Endothelial functions affected by sepsis include vasoregulation, barrier function, inflammation, and hemostasis. These are among other mechanisms often mediated by glycocalyx shedding, such as abnormal nitric oxide metabolism, up-regulation of reactive oxygen species generation due to down-regulation of endothelial-associated antioxidant defenses, transcellular communication, proteases, exposure of adhesion molecules, and activation of tissue factor. This review covers current insight in EC-associated hemostatic responses to sepsis and the EC response to inflammation. The endothelial cell lining is highly heterogeneous between different organ systems and consequently also in its response to sepsis. In this context, we discuss the response of the endothelial cell lining to sepsis in the kidney, liver, and lung. Finally, we discuss evidence as to whether the EC response to sepsis is adaptive or maladaptive. This study is a result of an Acute Dialysis Quality Initiative XIV Sepsis Workgroup meeting held in Bogota, Columbia, between October 12 and 15, 2014.Ítem Understanding the venous–arterial CO2 to arterial–venous O2 content difference ratio(Springer, 2016-11-12) Ospina-Tascón, Gustavo A.Introduction Early identification of tissue hypoperfusion is a cornerstone of shock management [1]. Normal macrohemodynamic and oxygen-derived parameters do not, however, rule out the presence of tissue hypoxia [2]. In this setting, carbon dioxide (CO2)-derived variables may provide information on macroand microvascular blood flow [3] and also on the presence of anaerobic metabolism [4, 5]. Importantly, variations in CO2 occur more rapidly than changes in lactate kinetics, making the former an attractive biomarker for monitoring, especially during the early stages of resuscitation [6, 7].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.