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Cardiovascular alterations in sepsis include a decrease in vascular tone and an impairment in myocardial contractility, and occur largely as the result of the release and action of mediators of the sepsis cascade. Many mediators are involved including cytokines, particularly tumour necrosis factor and interleukin-1, and secondary mediators such as nitric oxide and oxygen free radicals. The degree of reduced vascular tone and myocardial depression have both been related to the severity of sepsis. In this article we will review current knowledge on the factors involved in the cardiovascular alterations of sepsis, the clinical implications of these alterations, and the possibilities for future treatments.
taccone, fabio silvio; vincent, jean louis; lei, katie; sakr, yasser; spies, claudia; reinhart, konrad Author Information
There have really been no single, major, advances in critical care medicine since the specialty came into existence. There has, however, been a gradual, continuous improvement in the process of care over the years, which has resulted in improved patient outcomes. Here, we will highlight just a few of the paradigm shifts we have seen in processes of critical care, including the move from small, closed units to larger, more open ICUs; from a paternal "dictatorship" to more "democratic" team-work; from intermittent to continuous, invasive to less-invasive monitoring; from "more" interventions to "less" thus reducing iatrogenicity; from consideration of critical illness as a single event to realization that it is just one part of a trajectory; and from "four walls" to "no walls" as we take intensive care outside the physical ICU. These and other paradigm shifts have resulted in improvements in the whole approach to patient management, leading to more holistic, humane care for patients and their families. As critical care medicine continues to develop, further paradigm shifts in processes of care are inevitable and must be embraced if we are to continue to provide the best possible care for all critically ill patients.
The pulmonary artery catheter is still a valuable tool for hemodynamic monitoring when used in selected patients and by physicians adequately trained to correctly interpret and apply the data provided.
Vincent Jean. Les Chatelliers-Châteaumur (Vendée). Donjon de Châteaumur. In: Archéologie médiévale, tome 14, 1984. pp. 344-345.
