Critical illness and sepsis (circulation, ventilation and ethics)
01 / 2009 - unknown
As early identification of critical illness is widely acknowledged as a vital step towards improving survival, lactate monitoring has been introduced and high values are associated with high mortality rate. In a multi-center trial conducted in four centers in the region of Rotterdam, 348 patients were randomly allocated to either lactate- or non-lactate guided (controls) monitoring during the first eight hours of ICU stay. In patients with hyperlactatemia on ICU admission, lactate monitoring significantly reduced hospital mortality when adjusting for predefined risk factors. New techniques, like side stream dark field (SDF) imaging and laser speckle imaging has been studied for assessing microvascular perfusion in septic patients. In addition, near-infrared spectroscopy (NIRS) in combination with a vascular occlusion test is used to assess potential metabolic and microcirculatory alterations in the critically ill patients. In order to minimize inflammatory response in mechanically ventilated septic patients, new lung monitoring device (Electrical Impedance Tomography) is used to optimize ventilator settings.