Towards integrative physiological monitoring of the critically ill: from cardiovascular to microcirculatory and cellular function monitoring at the bedside.
Towards integrative physiological monitoring of the critically ill: from cardiovascular to microcirculatory and cellular function monitoring at the bedside.
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DOI：
10.1186/cc11503
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Ince C
中科院分区：
文献类型：
--
作者：
Donati A;Tibboel D;Ince C
目前危重病人的血流动力学监测主要集中在与体循环相关的压力衍生血流动力学变量的监测上。越来越多地，氧气运输途径和组织缺氧的存在指标正在被考虑。除了与向组织输送氧气有关的微循环参数外，收集关于细胞甚至亚细胞结构的功能活动的信息也变得越来越重要，以获得对疾病严重程度和治疗反应的综合评估。这些进展的关键是需要提供对患者生理和病理生理状态的连续测量，而不是对生物标记物的间歇性采样。随着对危重病人监测的技术研究和临床调查取得进展，越来越多的信息被提供给床边的临床医生。这种信息的复杂性需要整合被监测的变量，这需要基于生理学的数学模型来降低信息的复杂性，并为临床医生提供指导治疗和评估康复过程的路线图。在本文中，我们回顾了这些发展的技术现状，并对未来进行了预测，其中我们预测了一个能够将全身血液动力学和氧衍生变量与评估外周循环和微循环的变量相结合的生理监测环境，将这种实时监测扩展到细胞及其成分的功能活动。这样的监测环境将理想地将这些变量与各种器官系统的功能状态联系起来，因为器官功能代表了危重患者治疗支持的真正终点。
Current hemodynamic monitoring of critically ill patients is mainly focused on monitoring of pressure-derived hemodynamic variables related to systemic circulation. Increasingly, oxygen transport pathways and indicators of the presence of tissue dysoxia are now being considered. In addition to the microcirculatory parameters related to oxygen transport to the tissues, it is becoming increasingly clear that it is also important to gather information regarding the functional activity of cellular and even subcellular structures to gain an integrative evaluation of the severity of disease and the response to therapy. Crucial to these developments is the need to provide continuous measurements of the physiological and pathophysiological state of the patient, in contrast to the intermittent sampling of biomarkers. As technological research and clinical investigations into the monitoring of critically ill patients have progressed, an increasing amount of information is being made available to the clinician at the bedside. This complexity of information requires integration of the variables being monitored, which requires mathematical models based on physiology to reduce the complexity of the information and provide the clinician with a road map to guide therapy and assess the course of recovery. In this paper, we review the state of the art of these developments and speculate on the future, in which we predict a physiological monitoring environment that is able to integrate systemic hemodynamic and oxygen-derived variables with variables that assess the peripheral circulation and microcirculation, extending this real-time monitoring to the functional activity of cells and their constituents. Such a monitoring environment will ideally relate these variables to the functional state of various organ systems because organ function represents the true endpoint for therapeutic support of the critically ill patient.
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DOI：
10.1186/cc11236
发表时间：
2012-06-19
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bezemer R;Bartels SA;Bakker J;Ince C
通讯作者：
Ince C
影响因子：
3.7
作者：
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通讯作者：
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影响因子：
3.8
作者：
Goedhart, P. T.;Khalilzada, M.;Ince, C.
通讯作者：
Ince, C.
DOI：
10.1164/rccm.200109-016oc
发表时间：
2002-07-01
影响因子：
24.7
作者：
De Backer, D;Creteur, J;Vincent, JL
通讯作者：
Vincent, JL
影响因子：
38.9
作者：
Bracht, Hendrik;Krejci, Vladimir;Jakob, Stephan M.
通讯作者：
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