Pathophysiological mechanisms associated with the inflammatory re

Pathophysiological mechanisms associated with the inflammatory response lead to capillary leakage. Although crystalloids are isotonic, a significant amount of the volume given may migrate into the extra-vascular space due to #TPCA-1 price randurls[1|1|,|CHEM1|]# increased capillary permeability and changes in oncotic pressure. In patient with severe generalized peritonitis excessive infusion of fluids may become a counterproductive strategy. The frequency with which intra-abdominal hypertension develops in abdominal sepsis may have other important clinical consequences in addition to its impact on sepsis resuscitation endpoints. Current surviving sepsis guidelines emphasize the importance of

traditional mean arterial pressure (MAP) >65 mm Hg, central venous pressure (CVP) of 8–12 mmHg in combination with a central venous oxygen saturation (ScvO2) > 70% and Urine output >0.5 mL/kg/hr [11]. However, in patients with severe sepsis or septic shock C188-9 in vitro of abdominal origin, high intra-abdominal pressure may profoundly influence commonly used septic shock resuscitation endpoints such as CVP (falsely elevated) and urine output (markedly decreased). Repeated

intravesical measurements of intra-abdominal pressure should be frequently performed in patients with severe sepsis or septic shock of abdominal origin, to identify patients at risk for intra-abdominal hypertension. Monitoring the fluid status of critically ill patients at risk for intra-abdominal hypertension is crucial. In recent decades we have witnessed rapid advances in fluid monitoring techniques. Pulmonary artery catheters (PACs) have been widely used for more than three decades, but their usefulness in improving patient outcomes seems disappointing. Trials

have consistently shown that PACs do no improve patient outcomes and may significantly increase medical costs [71]. With the declining use of PACs, there has been an increasing number of alternatives for hemodynamic monitoring. Echocardiography is a useful noninvasive tool which can directly visualize the heart and assess cardiac function. Its use was long limited by the absence of accurate indices to diagnose hypovolemia and predict the effect of volume expansion. In the last years echocardiography has been Carnitine palmitoyltransferase II used to develop new parameters of fluid responsiveness, taking advantage of its ability to monitor cardiac function. Echocardiography has been shown to predict fluid responsiveness accurately and is now a complete and noninvasive tool able to accurately determine hemodynamic status in circulatory failure [72, 73]. It is strongly operator-dependent, and it does not allow continuous monitoring. The PiCCO system (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) is another interesting alternative.

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