Probing the limits of regional tissue oxygenation measures 英文参考文献.docVIP

Available online /content/13/S5/S1 Introduction Probing the limits of regional tissue oxygenation measures Michael R Pinsky1 and Didier Payen2 1Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA 2Department of Anesthesiology Critical Care, H?pital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, 2 rue Ambroise Paré, 75010 Paris, France Corresponding author: Didier Payen, dpayen1234@ Published: 30 November 2009 Critical Care 2009, 13(Suppl 5):S1 (doi:10.1186/cc7999) This article is online at /content/13/S5/S1 ? 2009 BioMed Central Ltd Assessment of tissue health is the Holy Grail in determining whether patients are in shock and when resuscitation efforts can be stopped because recovery has occurred. Tissue health, itself, results from the complex interaction between cardiac pump function, circulating blood volume and vasomotor tone, the number of capillary units perfused, and the ability of the tissue to use the delivered oxygen. Although the macro- circulation seems well evaluated both invasively and non- invasively using measures of blood pressure, cardiac output and mixed venous oxygen saturation, some studies suggest of continuous StO2 as a marker of tissue perfusion is still being studied, however, and potentially may demonstrate greater sensitivity early on in trauma resuscitation. Increased interest in functional hemodynamic monitoring [5], for which the fluid challenge or exercise stress test are classic examples, has recently been applied since observed static numbers cannot really evaluate the adequacy of tissue perfusion, especially regional measures of blood flow and tissue viability. Although systemic hypotension with hypo- perfusion, a low mixed venous oxygen saturation and elevated serum lactate levels may be