The Experts below are selected from a list of 51 Experts worldwide ranked by ideXlab platform
Belina D - One of the best experts on this subject based on the ideXlab platform.
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Pathophysiology of hemodynamic Shock (Circulatory failure). Part 2
Lijec̆nic̆ki vjesnik, 1999Co-Authors: Kovac Z, Belina DAbstract:In the second part of the review authors stress the importance of extent and duration of tissue Shock hypoenergosis and body reactive capacity for the clinical outcome of the syndrome. Functional restitution, decrease of functional organ capacity, permanent absence of certain organs' function and death, represent a possible clinical status caused by and developed during the Shock syndrome. Progressive pathologic alteration of tissue function and structure correlates well with the degree of tissue hypoenergosis. A short detailed description of the tissue alterations is outlined in the paper. The Shock syndrome very often consists of parallel pathogenic processes which therefore can be classified as a complex pathogenic forms of the Shock. A list of clinical disorders which develop due to a complex Shock pathogenesis, are outlined in the paper. Tentative relative contribution of individual pathogenic processes are estimated for various diseases. Clinical symptoms and signs, as well as laboratory parameters give a valuable information which points to the level of Shock development and reversibility. Correlation of clinical parameters and pathophysiologic processes are outlined. Simple predictive rules are re-discussed in the scope of underlying pathophysiology. In addition, a related hemodynamic disorders are shortly discussed in the paper.
Franco Díaz R - One of the best experts on this subject based on the ideXlab platform.
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La microcirculación en el paciente crítico: Parte I: generalidades y fisiología en el paciente séptico
Revista chilena de pediatría, 2013Co-Authors: Alejandro Donoso F, Daniela Arriagada S, Pablo Cruces R, Franco Díaz RAbstract:Microcirculation in the critically ill. Part I: Review and physiology of septic patients Severe sepsis and septic Shock involve Circulatory, inflammatory and metabolic disorders eventually resulting in a disruption of cellular energy. MicroCirculatory disturbances are common in septic patients. Microcir- culation is the primary site of oxygen and nutrients exchange to cells. Direct observation using Sidestream Dark Field (SDF) imaging has allowed direct visualization of microCirculatory failure in critically ill patients. Septic Shock is characterized by weak or vulnerable microCirculatory units and heterogeneity of microcircula- tory flow. Multiple mechanisms may contribute to these alterations, including endothelial dysfunction, altered glycocalyx, impaired inter-cell communication and adhesion and rolling of white blood cells and platelets. Many therapeutic interventions routinely used in the treatment of critically ill patients seem to result in limi- ted changes in microCirculatory perfusion, irrespective of systemic hemodynamics, due to the heterogeneous nature of these changes and the potentially involved mechanisms. Therefore, microCirculatory alterations and their presence in states of Shock, especially in septic Shock, can represent diagnostic and severity stratification tools and may be a target for therapeutic intervention (microCirculatory resuscitation), besides suggesting a prognostic role. (Key words: Microcirculation, endothelium, capillary, sepsis, Shock, Circulatory failure, organ failure). Rev Chil Pediatr 2013; 84 (1): 83-92
W. Kasper - One of the best experts on this subject based on the ideXlab platform.
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Clinical course and prognosis of acute pulmonary embolism
Intensivmedizin und Notfallmedizin, 2000Co-Authors: S. Konstantinides, A. Geibel, W. KasperAbstract:Effective treatment of acute pulmonary embolism (PE) requires prompt identification of patients at high risk of death or severe cardiovascular complications during the hospital stay. Determination of prognostic parameters in this heterogeneous patient population is far more important than calculation of a crude mortality rate due to PE. The multicenter Management Strategy and Prognosis in Pulmonary Embolism Registry examined the in-hospital clinical course of 1001 consecutive patients with acute PE. Overall mortality was 22%, with 91% of deaths directly related to PE. Clinical signs of acute right heart failure due to major PE (arterial hypotension, Shock, Circulatory collapse) were clearly associated with an adverse outcome. Mortality ranged from 8 to 65% depending on the severity of clinical instability at presentation. Importantly, a significantly increased death rate was also observed in patients with echocardiographically detected right ventricular dilation (84 vs. 16%), a reliable noninvasive index of impending right heart failure. The independent prognostic effect of this finding was confirmed by multivariate analysis (Odds Ratio, 2.44; P =0.004). Thus, the combination of clinical and echocardiographic findings permits accurate risk stratification of patients with acute PE. Evidence is also accumulating that these prognostic factors can be used to identify candidates for early thombolytic treatment.
Kovac Z - One of the best experts on this subject based on the ideXlab platform.
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Pathophysiology of hemodynamic Shock (Circulatory failure). Part 2
Lijec̆nic̆ki vjesnik, 1999Co-Authors: Kovac Z, Belina DAbstract:In the second part of the review authors stress the importance of extent and duration of tissue Shock hypoenergosis and body reactive capacity for the clinical outcome of the syndrome. Functional restitution, decrease of functional organ capacity, permanent absence of certain organs' function and death, represent a possible clinical status caused by and developed during the Shock syndrome. Progressive pathologic alteration of tissue function and structure correlates well with the degree of tissue hypoenergosis. A short detailed description of the tissue alterations is outlined in the paper. The Shock syndrome very often consists of parallel pathogenic processes which therefore can be classified as a complex pathogenic forms of the Shock. A list of clinical disorders which develop due to a complex Shock pathogenesis, are outlined in the paper. Tentative relative contribution of individual pathogenic processes are estimated for various diseases. Clinical symptoms and signs, as well as laboratory parameters give a valuable information which points to the level of Shock development and reversibility. Correlation of clinical parameters and pathophysiologic processes are outlined. Simple predictive rules are re-discussed in the scope of underlying pathophysiology. In addition, a related hemodynamic disorders are shortly discussed in the paper.
Alejandro Donoso F - One of the best experts on this subject based on the ideXlab platform.
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La microcirculación en el paciente crítico: Parte I: generalidades y fisiología en el paciente séptico
Revista chilena de pediatría, 2013Co-Authors: Alejandro Donoso F, Daniela Arriagada S, Pablo Cruces R, Franco Díaz RAbstract:Microcirculation in the critically ill. Part I: Review and physiology of septic patients Severe sepsis and septic Shock involve Circulatory, inflammatory and metabolic disorders eventually resulting in a disruption of cellular energy. MicroCirculatory disturbances are common in septic patients. Microcir- culation is the primary site of oxygen and nutrients exchange to cells. Direct observation using Sidestream Dark Field (SDF) imaging has allowed direct visualization of microCirculatory failure in critically ill patients. Septic Shock is characterized by weak or vulnerable microCirculatory units and heterogeneity of microcircula- tory flow. Multiple mechanisms may contribute to these alterations, including endothelial dysfunction, altered glycocalyx, impaired inter-cell communication and adhesion and rolling of white blood cells and platelets. Many therapeutic interventions routinely used in the treatment of critically ill patients seem to result in limi- ted changes in microCirculatory perfusion, irrespective of systemic hemodynamics, due to the heterogeneous nature of these changes and the potentially involved mechanisms. Therefore, microCirculatory alterations and their presence in states of Shock, especially in septic Shock, can represent diagnostic and severity stratification tools and may be a target for therapeutic intervention (microCirculatory resuscitation), besides suggesting a prognostic role. (Key words: Microcirculation, endothelium, capillary, sepsis, Shock, Circulatory failure, organ failure). Rev Chil Pediatr 2013; 84 (1): 83-92