BOOK
Monitoring Tissue Perfusion and Oxygenation, An Issue of Critical Nursing Clinics, E-Book
(2014)
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Book Details
Abstract
Critical care clinicians must be knowledgeable about the anatomic, physiologic, and biochemical processes that are critical to the restoration of a functioning microvascular affecting organ perfusion. These basic physiologic processes critical to tissue perfusion and cellular oxygenation are presented in this issue on Monitoring Tissue Perfusion and Oxygenation. A working knowledge of oxygen delivery and oxygen consumption at the microvascular level will provide critical information needed for clinicians to continuously question the adequacy of tissue perfusion given our current lack of microvascular bedside monitoring.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Monitoring Tissue Perfusionand Oxygenation\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | v | ||
| Critical Care Nursing Clinics Of North America\r | viii | ||
| Preface\r | ix | ||
| A Historical Perspective on the Development of Modern Concepts of Tissue Perfusion | 297 | ||
| Key points | 297 | ||
| Introduction | 297 | ||
| Anatomic era | 298 | ||
| The Greeks | 299 | ||
| Galen of Pergamon | 300 | ||
| The Arabic World | 300 | ||
| The Renaissance | 302 | ||
| William Harvey | 302 | ||
| Microscopic Anatomy | 303 | ||
| Physiology and biochemistry era | 303 | ||
| Oxygen and Hemoglobin | 305 | ||
| Cellular Metabolism | 306 | ||
| Summary | 308 | ||
| References | 308 | ||
| Microcirculatory Oxygen Transport and Utilization | 311 | ||
| Key points | 311 | ||
| Introduction | 311 | ||
| Anatomy and physiology of circulation | 312 | ||
| Arterioles | 312 | ||
| Capillaries | 313 | ||
| Capillary Density | 314 | ||
| Arteriolar Regulation | 315 | ||
| Endothelium | 316 | ||
| Red Blood Cell | 316 | ||
| Blood Flow | 317 | ||
| Fundamentals of oxygen transport and utilization | 318 | ||
| Convective Oxygen Transport | 318 | ||
| Diffusive Oxygen Transport | 318 | ||
| Oxygen consumption | 320 | ||
| Macrocirculation versus microcirculation | 321 | ||
| Summary | 322 | ||
| References | 322 | ||
| The Physiologic Role of Erythrocytes in Oxygen Delivery and Implications for Blood Storage | 325 | ||
| Key points | 325 | ||
| Introduction | 325 | ||
| Hb in an erythrocyte actively responds to its local environment | 326 | ||
| The microcirculation is designed to respond to local tissue needs | 327 | ||
| Capillary endothelial cells create a metabolic link between the tissue and the blood | 327 | ||
| Hb is a heterogeneous and sensitive molecule | 328 | ||
| Hb carries and releases the potent vasodilator NO | 330 | ||
| Storing erythrocytes alters their optimal function | 330 | ||
| Does RBC storage time matter? | 331 | ||
| How does storage affect the erythrocyte? | 332 | ||
| Biopreservation of erythrocytes | 332 | ||
| Summary | 333 | ||
| References | 333 | ||
| Basic Concepts of Hemorheology in Microvascular Hemodynamics | 337 | ||
| Key points | 337 | ||
| Introduction | 337 | ||
| Composition of blood | 338 | ||
| Principles of rheology | 339 | ||
| Hemorheology | 339 | ||
| Blood Viscosity | 340 | ||
| Erythrocyte Deformability | 341 | ||
| Erythrocyte Aggregation | 341 | ||
| Role of leukocytes in resistance | 343 | ||
| Summary | 343 | ||
| References | 343 | ||
| Monitoring Tissue Blood Flow and Oxygenation | 345 | ||
| Key points | 345 | ||
| Introduction | 345 | ||
| Measurement in clinical practice | 346 | ||
| Measurement of Tissue Oxygenation | 348 | ||
| Monitors of Perfusion in the Microcirculation | 348 | ||
| Near-infrared resonance spectroscopy | 348 | ||
| Laser Doppler flowmetry | 351 | ||
| Videomicroscopic techniques | 352 | ||
| Monitors of the Extracellular Environment | 353 | ||
| Tissue oxygen tension | 353 | ||
| Tissue carbon dioxide | 353 | ||
| Lactate | 354 | ||
| Summary | 355 | ||
| References | 355 | ||
| Exploring Hemodynamics | 357 | ||
| Key points | 357 | ||
| Introduction | 357 | ||
| From cardiac pressures to parameters based on blood flow | 358 | ||
| Use of SV to assess fluid responsiveness | 358 | ||
| SV Optimization | 358 | ||
| Passive Leg Raise Maneuver | 361 | ||
| Techniques for assessing SV at the bedside | 362 | ||
| PAC | 363 | ||
| Doppler Techniques | 363 | ||
| Description | 363 | ||
| Techniques | 363 | ||
| Advantages | 363 | ||
| Disadvantages | 364 | ||
| Supporting literature | 364 | ||
| Summary of Doppler techniques | 365 | ||
| Pulse Contour Method | 366 | ||
| Description | 366 | ||
| Techniques | 367 | ||
| Advantages | 368 | ||
| Disadvantages | 368 | ||
| Supporting literature | 368 | ||
| Summary | 369 | ||
| Bioimpedance and Bioreactance | 369 | ||
| Description | 369 | ||
| Techniques | 369 | ||
| Advantages | 369 | ||
| Disadvantages | 369 | ||
| Supporting literature | 369 | ||
| Summary | 370 | ||
| Exhaled CO2 Method and Capnometry | 370 | ||
| Exhaled CO2 method | 370 | ||
| Capnometry | 370 | ||
| Summary | 371 | ||
| References | 372 | ||
| The Experience of Family Members of ICU Patients Who Require Extensive Monitoring | 377 | ||
| Key points | 377 | ||
| Introduction | 377 | ||
| Definition | 378 | ||
| Literature review | 378 | ||
| Family Member Communication | 378 | ||
| Family Needs | 379 | ||
| Theoretic framework | 380 | ||
| Study design | 380 | ||
| Qualitative methodology | 380 | ||
| Hermeneutic Phenomenology | 381 | ||
| Family Research | 381 | ||
| Quantitative methodology | 381 | ||
| Instruments | 381 | ||
| Data analysis | 382 | ||
| Qualitative Data | 382 | ||
| Quantitative Data | 382 | ||
| Findings | 382 | ||
| Qualitative | 382 | ||
| Quantitative | 384 | ||
| Discussion | 384 | ||
| Limitations | 386 | ||
| References | 387 | ||
| Brain Perfusion and Oxygenation | 389 | ||
| Key points | 389 | ||
| Physiology of brain perfusion and oxygenation | 389 | ||
| Cerebral Metabolism | 389 | ||
| CBF | 390 | ||
| Determinants of CBF | 390 | ||
| Blood-Brain Barrier | 391 | ||
| Brain Injury | 391 | ||
| Neuromonitoring techniques | 392 | ||
| ICP | 392 | ||
| CPP | 392 | ||
| TCD | 392 | ||
| Jugular Venous Oxygenation | 393 | ||
| Brain Tissue Oxygen Tension | 393 | ||
| Cerebral Microdialysis | 394 | ||
| NIRS | 394 | ||
| Adjunctive Neuromonitoring Techniques | 395 | ||
| Brain Imaging for Cerebral Perfusion | 395 | ||
| Summary | 395 | ||
| References | 396 | ||
| Microcirculatory Alterations in Shock States | 399 | ||
| Key points | 399 | ||
| Introduction | 400 | ||
| General principles of microvascular function | 400 | ||
| Convective and Diffusive Oxygen Transport | 400 | ||
| Endothelium and Nitric Oxide | 400 | ||
| Blood and Blood Flow | 401 | ||
| Microcirculation alterations in hypovolemic shock | 401 | ||
| Microcirculation alterations in cardiogenic shock | 402 | ||
| Microvascular alterations in septic shock | 402 | ||
| Endothelial Dysfunction | 403 | ||
| Nitric Oxide and the Microcirculation | 404 | ||
| Blood Alterations | 405 | ||
| Blood Flow Alterations | 405 | ||
| Diffusive Oxygen Transport Alterations | 405 | ||
| Alteration in Oxygen Utilization—Dysoxia | 406 | ||
| Conclusions and implications | 407 | ||
| References | 407 | ||
| Vasopressor Weaning in Patients with Septic Shock | 413 | ||
| Key points | 413 | ||
| Introduction | 413 | ||
| Pathophysiology of sepsis and hypotension | 414 | ||
| Treatment guidelines for sepsis | 414 | ||
| Surviving Sepsis Campaign Guidelines | 416 | ||
| Early Goal-directed Therapy | 416 | ||
| Autoregulation of blood flow | 417 | ||
| Vasopressors used in the management of septic shock | 417 | ||
| Receptors | 418 | ||
| Vasopressors | 418 | ||
| Vasopressor weaning | 420 | ||
| Prioritization of Vasopressor Weaning | 420 | ||
| Weaning Prototype | 421 | ||
| Optimal monitoring of patients with vasopressor therapy | 422 | ||
| New directions in sepsis research with implications for vasopressor therapy and titration | 423 | ||
| Summary | 424 | ||
| References | 424 | ||
| Index | 427 |