Browsing by Author "Ince, Can"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Effect of Polyethylene-glycolated Carboxyhemoglobin on Renal Microcirculation in a Rat Model of Hemorrhagic Shock
    (2019) Guerci, Philippe; Ergin, Bulent; Kapucu, Aysegui; Hilty, Matthias P.; Jubin, Roland; Bakker, Jan; Ince, Can
  • Thumbnail Image
    Item
    Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study
    (2013) Hernández P., Glenn; Bruhn, Alejandro; Luengo Messen, Cecilia; Regueira Heskia, Tomás; Kattan Tala, Eduardo José; Fuentealba, Andrea; Florez, Jorge; Castro López, Ricardo; Aquevedo Salazar, Andrés Fernando; Pairumani, Ronald; Mc-Nab Martin, Paul Andrew; Ince, Can
  • Thumbnail Image
    Item
    Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study
    (W B SAUNDERS CO-ELSEVIER INC, 2012) Hernandez, Glenn; Pedreros, Cesar; Veas, Enrique; Bruhn, Alejandro; Romero, Carlos; Rovegno, Maximiliano; Neira, Rodolfo; Bravo, Sebastian; Castro, Ricardo; Kattan, Eduardo; Ince, Can
    Purpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
  • No Thumbnail Available
    Item
    Microcirculation in Sepsis: New Perspectives
    (2013) Hernandez, Glenn; Bruhn, Alejandro; Ince, Can
    Microcirculatory dysfunction has been recently recognized as a key pathophysiologic process in the evolution of sepsis. In the present review, we discuss fundamental aspects of microcirculatory abnormalities during septic shock, including pathogenic mechanisms, technological assessment, clinical correlates and potential therapies. The most important function of the microcirculation is the regulation and distribution of flow within the different organs. In septic shock, microcirculatory dysfunction may arise as a result of several factors such as endothelial dysfunction, leukocyte-endothelium interactions, coagulation and inflammatory disorders, hemorheologic abnormalities, and functional shunting. Severity and persistence of these microcirculatory abnormalities are associated with bad prognosis and are not necessarily predicted by systemic variables. The introduction of bedside techniques that allow evaluation of the microcirculation into clinical practice has opened up a new field of functional hemodynamic monitoring. Recent data suggest that microcirculatory abnormalities can be staged in severity. Some microcirculatory indices are more accurately related to morbidity and mortality, and thus a definition of clinically relevant microcirculatory abnormalities is feasible. On the other hand, although several systemic variables do not predict microcirculatory status, high norepinephrine (NE) requirements and hyperlactatemia are associated with a much higher prevalence of relevant microcirculatory derangements. Therefore, severe septic shock patients could represent a more precise target for interventions, particularly in microcirculation-oriented clinical trials. Clinical research has identified various therapeutic approaches that are successful in modifying the microcirculation. Future research must determine whether some of these approaches are successful in improving outcome of critically ill patients by recruiting the microcirculation.
  • Thumbnail Image
    Item
    Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study
    (2012) Hernández P., Glenn; Regueira Heskia, Tomás; Bruhn, Alejandro; Castro López, Ricardo; Rovegno Echavarria, Maxiliano; Fuentealba, Andrea; Veas, Enrique; Florez, Jorge; Kattan Tala, Eduardo José; Martin, Celeste; Ince, Can; Berrutti, Dolores
    Abstract Background Recent clinical studies have confirmed the strong prognostic value of persistent hyperlactatemia and delayed lactate clearance in septic shock. Several potential hypoxic and nonhypoxic mechanisms have been associated with persistent hyperlactatemia, but the relative contribution of these factors has not been specifically addressed in comprehensive clinical physiological studies. Our goal was to determine potential hemodynamic and perfusion-related parameters associated with 6-hour lactate clearance in a cohort of hyperdynamic, hyperlactatemic, septic shock patients. Methods We conducted an acute clinical physiological pilot study that included 15 hyperdynamic, septic shock patients undergoing aggressive early resuscitation. Several hemodynamic and perfusion-related parameters were measured immediately after preload optimization and 6 hours thereafter, with 6-hour lactate clearance as the main outcome criterion. Evaluated parameters included cardiac index, mixed venous oxygen saturation, capillary refill time and central-to-peripheral temperature difference, thenar tissue oxygen saturation (StO2) and its recovery slope after a vascular occlusion test, sublingual microcirculatory assessment, gastric tonometry (pCO2 gap), and plasma disappearance rate of indocyanine green (ICG-PDR). Statistical analysis included Wilcoxon and Mann–Whitney tests. Results Five patients presented a 6-hour lactate clearance <10%. Compared with 10 patients with a 6-hour lactate clearance ≥10%, they presented a worse hepatosplanchnic perfusion as represented by significantly more severe derangements of ICG-PDR (9.7 (8–19) vs. 19.6 (9–32)%/min, p < 0.05) and pCO2 gap (33 (9.1-62) vs. 7.7 (3–58) mmHg, p < 0.05) at 6 hours. No other systemic, hemodynamic, metabolic, peripheral, or microcirculatory parameters differentiated these subgroups. We also found a significant correlation between ICG-PDR and pCO2 gap (p = 0.02). Conclusions Impaired 6-hour lactate clearance could be associated with hepatosplanchnic hypoperfusion in some hyperdynamic septic shock patients. Improvement of systemic, metabolic, and peripheral perfusion parameters does not rule out the persistence of hepatosplanchnic hypoperfusion in this setting. Severe microcirculatory abnormalities can be detected in hyperdynamic septic shock patients, but their role on lactate clearance is unclear. ICG-PDR may be a useful tool to evaluate hepatosplanchnic perfusion in septic shock patients with persistent hyperlactatemia. Trial registration ClinicalTrials.gov Identifier: NCT01271153
  • Thumbnail Image
    Item
    Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine
    (2018) Ince, Can; Boerma, E. Christiaan; Cecconi, Maurizio; De Backer, Daniel; Shapiro, Nathan I.; Duranteau, Jacques; Pinsky, Michael R.; Artigas, Antonio; Hernández P., Glenn; Bakker, Jan; et al.
  • Thumbnail Image
    Item
    The Endothelium in Sepsis
    (2016) Ince, Can; Mayeux, Philip R.; Nguyen, Trung; Gómez, Hernando; Kellum, John A.; Ospina Tascón, Gustavo A.; Hernández P., Glenn; Murray, Patrick; De Backer, Daniel