Browsing by Author "Fuentealba, A."

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    Persistent sepsis-induced hypotension without hyperlactatemia: A distinct clinical and physiological profile within the spectrum of septic shock
    (2012) Hernández P., Glenn; Bruhn, Alejandro; Castro, R.; Pedreros, C.; Rovegno Echavarria, Maxiliano; Kattan Tala, Eduardo José; Veas, E.; Fuentealba, A.; Regueira Heskia, Tomás; Ruiz, C.; Ince, C.
    Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.
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    Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients
    (2013) Hernández P., Glenn; Boerma, C.; Dubin, A.; Bruhn, Alejandro; Koopmans, M.; Kanoore, V.; Ruiz Balart, Carolina; Castro López, Ricardo; Pozo M., Omar; Pedreros, C.; Veas, E.; Fuentealba, A.; Kattan Tala, Eduardo José; Rovegno Echavarria, Maxiliano