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By A. Gullo

Improving criteria of care is a true problem in in depth Care drugs. enhancing scientific functionality, sufferer defense, probability administration and audit represents the cornerstone for elevating the standard of care in ICU sufferers. verbal exchange is the platform from the place to begin to arrive a consensus in a really crowded region, a special multidisciplinary and multiprofessional surroundings during which caliber of care and, eventually, sufferer survival must be ameliorated.

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Natalini G, Rosano A, Taranto M et al (2006) Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg 103:1478-1484 22. Cannesson M, Delannoy B, Morand A et al (2007) New algorithm for automatic estimation of the respiratory variations in the pulse oximeter waveform. Anesthesiology A452 Chapter 4 Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care U. UNGERSTEDT For decades we have discussed the possibilities that will open up once we have biosensors that can be implanted into individual organs providing us with invaluable bedside information about their metabolic state during intensive care.

We want to avoid the secondary damage whether it is due to ongoing chemical processes in the cells or due to the nature of our pharmacological and surgical interventions. Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care 33 Fig. 3. By detecting a change in organ chemistry before clinical signs become apparent treatment can start hours or even days earlier than would have been the case when clinical signs is the only source of information. A “window of opportunities” is created that may dramatically alter outcome measured as “tissue outcome” and possibly outcome as measured by a traditional outcome scale.

Ischaemia, that is an insufficient capillary blood flow, will limit the supply of oxygen and glucose forcing pyruvate to be metabolized to lactate in order to keep up the anaerobic energy production. The increase in lactate is soon followed by a decrease in pyruvate due to the decrease in glucose supplied by the capillary blood. The result will be an increase in the lactate/pyruvate ratio. Continuous Monitoring of Organ Chemistry – a Paradigm Shift in Management of Intensive Care 31 In the case of energy metabolism (Fig 1) it is of obvious value to sample glucose metabolism using markers such as glucose, lactate and pyruvate where the lactate/pyruvate ratio is a well known marker of the redox state of the tissue and an indicator of tissue ischaemia [6].

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