Acta Clin Belg
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Patients with sepsis often receive large amounts of fluids and the presence of capillary leak, trauma or bleeding results in ongoing fluid resuscitation. This increases interstitial and intestinal edema and finally leads to intra-abdominal hypertension (IAH), which in turn impedes lymphatic drainage. Patients with IAH often develop secondary respiratory failure needing mechanical ventilation with high intrathoracic pressure or PEEP that might further alter lymphatic drainage. This review will try to convince the reader of the importance of the lymphatics in septic patients with IAH. ⋯ Although often overlooked the role of lymphatic flow is complex but very important to determine not only the fluid balance in the lung but also in the peripheral organs. Different pathologies and treatments can markedly influence the pathophysiology of the lymphatics with dramatic effects on endorgan function.
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Gastrointestinal failure (GIF) has been postulated as the motor of multiple organ dysfunction syndrome (MODS) but is not commonly included among other organ failures in scoring systems identifying MODS. ⋯ There is no consensus on definition of GIF and different medical specialties have different approaches. Development of a proper definition of GIF is warranted.
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Acute kidney injury (AKI) is a serious complication in critically-ill patients and portends a high mortality. The incidence of AKI continues to increase and is often underestimated. The intriguing question to both the intensivists and nephrologists is whether the kidney is an innocent bystander in the process of multi-organ systems failure or whether the kidney is initiating various complex metabolic and humoral pathways affecting distant organs contributing to the overall mortality. ⋯ Volume overload and acid-base derangements typical of renal dysfunction have serious consequences in the duration and weaning of mechanical ventilation. Recent animal studies suggest that acutely ischaemic kidneys may induce both functional and transcriptional changes in the lung, independent of uraemia. In this review, we have attempted to discuss various physiological derangements and their clinical effects, in the setting of AKI.
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Review
ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom?
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The number of publications describing and researching this phenomenon is increasing exponentially but there are still very limited data about treatment and outcome. ⋯ This paper describes current insights on management of IAP induced organ dysfunction and lists the most widely used and published non-invasive techniques to decrease IAP with their limitations and pitfalls.
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The microcirculation plays a major role in oxygen delivery and organ perfusion, and is largely involved in the pathophysiological alterations of shock states. It has been a focus of research for a long time, but human clinical and physiological studies have been limited by a lack of reliable techniques available at the bedside. Intravital microscopy, although of interest in experimental studies, is not feasible in human studies. ⋯ Recently, the Orthogonal Polarized Spectral (OPS) imaging technique has enabled the study of the microcirculation in humans. This technique has allowed a better definition of microcirculatory alterations in disease states, defined the role of some medical interventions, and been used to predict outcome. In this text, we briefly describe the techniques available to study the microcirculation and review experimental and human studies in this domain.