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Cardiovascular disturbances associated with sepsis cause hypoperfusion situations, which will negatively impact these patients' prognosis. The aim of haemodynamic monitoring is to guide the detection and correction of this hypoperfusion, and assist in decision making in optimising oxygen transport to tissues, primarily by manipulating cardiac output. This review seeks to summarise the different parameters of haemodynamic monitoring, the objectives of resuscitation, the physiological parameters, and the tools available to us for appropriate cardiac output manipulation., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Objective: Hemodynamic resuscitation is considered a cornerstone of the initial treatment of septic shock. However, there is growing concern about its side effects. Our objective was to assess the relationship between fluid administration and norepinephrine infusion and the development of lung injury., Design: Randomized in vivo study in rabbits., Setting: University animal research laboratory., Patients: Eighteen New Zealand rabbits. Control group (SHAM, n=6), Sepsis group with or without hemodynamic resuscitation (ETX-R, n=6; ETX-NR, n=6)., Interventions: Sepsis was induced by intravenous lipopolysaccharide administration and animals were followed-up for 4h. Hemodynamic resuscitation with Ringer lactate (20mL·kg -1 ) was administered and later norepinephrine was initiated 3h after sepsis induction. At the end, the left lung was excised., Main Variables of Interest: An indwelling arterial catheter and an esophageal Doppler were placed. Lung mechanics were monitored with side stream spirometry. Lung damage was analyzed by histopathological examination., Results: The SHAM group did not show hemodynamic or respiratory changes. Lipopolysaccharide administration aimed an increase in cardiac output and arterial hypotension. In the ETX-NR group, animals remained hypotensive until the end of the experiment. Resuscitation with fluids and norepinephrine reversed arterial hypotension. Compared to the ETX-NR group, the remaining lung of the ETX-R group showed greater accumulation of neutrophils and reactive type-II pneumocytes, thicker alveolar wall, alveolar hemorrhage and non-aerated pulmonary areas. Lung injury score was larger in the ETX-R group., Conclusions: In our experimental study, following a strategy with bolus fluids and late norepinephrine used in the early phase of endotoxic septic shock has a negative influence on the development of lung injury., (Copyright © 2020 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Objective: Hemodynamic resuscitation is considered a cornerstone of the initial treatment of septic shock. However, there is growing concern about its side effects. Our objective was to assess the relationship between fluid administration and norepinephrine infusion and the development of lung injury., Design: Randomized in vivo study in rabbits., Setting: University animal research laboratory., Patients: Eighteen New Zealand rabbits. Control group (SHAM, n=6), Sepsis group with or without hemodynamic resuscitation (ETX-R, n=6; ETX-NR, n=6)., Interventions: Sepsis was induced by intravenous lipopolysaccharide administration and animals were followed-up for 4h. Hemodynamic resuscitation with Ringer lactate (20mL·kg -1 ) was administered and later norepinephrine was initiated 3h after sepsis induction. At the end, the left lung was excised., Main Variables of Interest: An indwelling arterial catheter and an esophageal Doppler were placed. Lung mechanics were monitored with side stream spirometry. Lung damage was analyzed by histopathological examination., Results: The SHAM group did not show hemodynamic or respiratory changes. Lipopolysaccharide administration aimed an increase in cardiac output and arterial hypotension. In the ETX-NR group, animals remained hypotensive until the end of the experiment. Resuscitation with fluids and norepinephrine reversed arterial hypotension. Compared to the ETX-NR group, the remaining lung of the ETX-R group showed greater accumulation of neutrophils and reactive type-II pneumocytes, thicker alveolar wall, alveolar hemorrhage and non-aerated pulmonary areas. Lung injury score was larger in the ETX-R group., Conclusions: In our experimental study, following a strategy with bolus fluids and late norepinephrine used in the early phase of endotoxic septic shock has a negative influence on the development of lung injury., (Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Objective: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors., Design: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017., Scope: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors., Patients: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors., Interventions: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors., Variables: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function., Results: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (μ=22.8 mmHg) and in the kidneys discarded for transplantation (μ=17.35 mmHg)., Conclusions: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors., (Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)