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A01 Assessing the Microcirculation Educational Objectives: 1. Discuss the different methods for evaluating the microcirculation Rolando Claure MD 4:00-5:30 Tuesday, February 14 2. To review the different scores available for microcirculation analysis, and which measurements should be included. 3. Discuss how monitoring of the microcirculation may help us at the bedside Content Description: Microvascular perfusion plays an important role in the development of organ failure in hospitalized patients. Although microcirculation is the primary site of oxygen and nutrient exchange, microvascular oxygen delivery cannot be predicted <strong>from</strong> global hemodynamic measurements. Hemodynamic assessment has been limited to measurements of cardiac output and oxygen delivery, which are indirect measurements of microcirculation. However, several observational studies and randomized controlled trials trying to improve these parameters based on information derived <strong>from</strong> pulmonary artery catheter have shown no benefits in outcomes. In critically-ill patients improvement in microvascular perfusion should be to one of the major therapeutic goals. Recent advances in technology have allowed direct visualization of the microcirculation. The octagonal polarization spectral (OPS) and the side stream dark field (SDF) imaging devices provide high contrast images of the microvasculature. Experimental studies have shown alterations in the microcirculation common to different pathological process. OPS and SDF imaging have been used to assess microvascular alterations in many disease processes such as: sepsis, painful crises in sickle cell disease, bacterial infection in cirrhosis, leukostasis in patients with chronic myeloid leukemia, and changes in the volume status of hemodialysis patient. It has also been used to assess the effect of different therapies on microcirculation in experimental animal models and in septic patients. Additionally, in critically-ill patients with sepsis and septic shock, recent studies have correlated microcirculatory flow abnormalities with hemodynamics, oxygen transport and survival. The introduction of OPS and SDF imaging has opened challenging new perspectives in in vivo research of microcirculatory alterations, and has highlighted the importance of microcirculatory alterations in multiple organ failure and sepsis. Suggested Reading: 1. van Beers EJ, Goedhart PT, Unger M, Biemond BJ, Ince C. Normal sublingual microcirculation during painful crisis in sickle cell disease. Microvascular Research 76:57 60, 2008. 2. Sheikh, M. Y., U. Javed, et al. Bedside Sublingual Video Imaging of Microcirculation in Assessing Bacterial Infection in Cirrhosis. Dig Dis Sci, 2009 3. Boerma EC, van del Voort PHJ, Spronk PE, et al. Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis. Crit Care Med 35:1055 1060, 2007. 4. Trzeciak S, Dellinger PR, Parrillo JE, et al: Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: Relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med 49:88-98, 2007. 71
5. Johannes T, Mik EG, Nohé B, et al: Influence of fluid resuscitation on renal microvascular PO2 in a normotensive rat model of endotoxemia. Crit Care 10:R88, 2006. 6. Sakr Y, Chierego M, Piagnerelli M, et al: Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med 35:1639 1644, 2007. 7. De Backer D, Creteur J, MD, PhD; Dubois MJ, et al: The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 34:403–408, 2006. 8. Verdant C, De Backer D. How monitoring of the microcirculation may help us at the bedside. Curr Opin Crit Care 11:240-244, 2005. 9. Dobbe JGG, Streekstra GJ, Atasever B, et al: Measurement of functional microcirculatory geometry and velocity distributions using automated image analysis. Med Biol Eng Comput 46:659-670, 2008. 10. Dubin A, Pozo M.O., Casabella Ch.A., et. Al. Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care 13:R92, 2009. 72
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CRRT 2012 SEVENTEENTH INTERNATIONAL
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FACULTY DISCLOSURES CRRT 2012 Facul
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CRRT 2012 ORGANIZING COMMITTEE USA
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CRRT 2012 FACULTY Patrick Honoré,
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ACKNOWLEDGEMENTS CRRT 2012 ACKNOWLE
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PLENARY SESSIONS CRRT 2012 PROGRAM/
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WORKSHOPS CRRT 2012 PROGRAM/INDEX T
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WORKSHOPS CRRT 2012 PROGRAM/INDEX W
Page 22 and 23: POSTER ABSTRACTS C
Page 24 and 25: POSTER ABSTRACTS C
Page 26 and 27: NURSING FORUM LUNCHEON Communicatio
Page 28 and 29: Nutritional Support in ICU Patients
Page 30 and 31: Educational Objectives: The Endothe
Page 32 and 33: SPECIAL LECTURE Engineering Critica
Page 34 and 35: Nishimura R, Ornato JP, Page RL, Ri
Page 36 and 37: Do Vasoactive Drugs and Fluids Impr
Page 38 and 39: Blood Transfusions are Important fo
Page 40 and 41: Thinking Outside of the Box: A Nove
Page 42 and 43: Nursing Forum 2 Luncheon Benchmarki
Page 44 and 45: 4. Mori K, Lee HT, Rapoport D, Drex
Page 46 and 47: Differential Diagnosis of AKI: Can
Page 48 and 49: Myocardial Stunning and Brain Edema
Page 50 and 51: 4. Udy A, Roberts JA, Lipman J. Wha
Page 52 and 53: CRRT and ECMO: Techniques and Outco
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Page 56 and 57: Avoiding Anticoagulation for CRRT:
Page 58 and 59: Improving Outcomes from</st
Page 60 and 61: The Changing Face of AKI: Snapshots
Page 62 and 63: Alkaline Phosphatase Peter Pickkers
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Page 66 and 67: Surveillance and Early Recognition
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Page 70 and 71: A01 Assessing the Microcirculation
Page 74 and 75: C03 Critical Care Pharmacology: Vas
Page 76 and 77: D04 Biomarkers 1: Principles and Ap
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Page 80 and 81: G07 Fluids and Solutions in the Cri
Page 82 and 83: A09 Vascular Access /Membrane and C
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Page 86 and 87: C11 Critical Care Management: Nutri
Page 88 and 89: D12 Biomarkers 2: Application in AK
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Page 92 and 93: G15 Fluids and Solutions in the Cri
Page 94 and 95: Educational Objectives: 1) Discuss
Page 96 and 97: B18 Fluid Management Ravindra L. Me
Page 98 and 99: C19 Acid Base and Electrolyte Probl
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Page 104 and 105: F22 Ensuring Patient Safety and Qua
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Page 110 and 111: C27 Acid Base and Electrolyte Probl
Page 112 and 113: D28 Extracorporeal Techniques for S
Page 114 and 115: E29 Heart Failure and Cardio-Renal
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Page 118 and 119: H32 Withdrawing & Withholding Suppo
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