TY - JOUR
T1 - Vascular content, tone, integrity, and haemodynamics for guiding fluid therapy: a conceptual approach
AU - Chawla, L. S.
AU - Ince, C.
AU - Chappell, D.
AU - Gan, T. J.
AU - Kellum, J. A.
AU - Mythen, M.
AU - Shaw, A. D.
PY - 2014
Y1 - 2014
N2 - Background. Despite many clinical trials and investigative efforts to determine appropriate therapeutic intervention(s) for shock, this topic remains controversial. The use of i.v. fluid has represented the cornerstone for the treatment of hypoperfusion for two centuries. Methods. As a part of International Acute Dialysis Quality Initiative XII Fluids Workgroup meeting, we sought to incorporate recent advances in our understanding of vascular biology into a more comprehensive yet accessible approach to the patient with hypoperfusion. In this workgroup, we attempted to develop a framework that incorporates key aspects of the vasculatu re into a diagnostic approach. Results. The four main components of our proposal involve the assessment ofthe blood flow (BF), vascular content (vC), the vascular barrier (vB), and vascular tone (vT). Any significant perturbation in any of these domains can lead to hypoperfusion at both the macro- and micro-circulatory level. We have termed the BF, vC, vB, and vTdiagnostic approach the vascular component (VC) approach. Conclusions. The VC approach to hypoperfusion has potential advantages to the current diagnostic system. This approach also has the distinct advantage that it can be used to assess the systemic, regional, and micro-vasculature, thereby harmonizing the approach to clinical vascular diagnostics across these levels. The VC approach will need to be tested prospectively to determine if this system can in fact improve outcomes in patients who suffer from hypoperfusion
AB - Background. Despite many clinical trials and investigative efforts to determine appropriate therapeutic intervention(s) for shock, this topic remains controversial. The use of i.v. fluid has represented the cornerstone for the treatment of hypoperfusion for two centuries. Methods. As a part of International Acute Dialysis Quality Initiative XII Fluids Workgroup meeting, we sought to incorporate recent advances in our understanding of vascular biology into a more comprehensive yet accessible approach to the patient with hypoperfusion. In this workgroup, we attempted to develop a framework that incorporates key aspects of the vasculatu re into a diagnostic approach. Results. The four main components of our proposal involve the assessment ofthe blood flow (BF), vascular content (vC), the vascular barrier (vB), and vascular tone (vT). Any significant perturbation in any of these domains can lead to hypoperfusion at both the macro- and micro-circulatory level. We have termed the BF, vC, vB, and vTdiagnostic approach the vascular component (VC) approach. Conclusions. The VC approach to hypoperfusion has potential advantages to the current diagnostic system. This approach also has the distinct advantage that it can be used to assess the systemic, regional, and micro-vasculature, thereby harmonizing the approach to clinical vascular diagnostics across these levels. The VC approach will need to be tested prospectively to determine if this system can in fact improve outcomes in patients who suffer from hypoperfusion
U2 - https://doi.org/10.1093/bja/aeu298
DO - https://doi.org/10.1093/bja/aeu298
M3 - Article
C2 - 25231767
SN - 0007-0912
VL - 113
SP - 748
EP - 755
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 5
ER -