Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: A hypothesis generating post hoc analysis

Background: Microcirculatory driving pressure is defined as the difference between post-arteriolar and venular pressure. In previous research, an absence of correlation between mean arterial blood pressure (MAP) and microcirculatory perfusion has been observed. However, the microcirculation may be considered as a low pressure compartment with capillary pressure closer to venous than to arterial pressure. From this perspective, it is conceivable that central venous pressure (CVP) plays a more important role in determination of capillary perfusion. We aimed to explore associations between CVP and microcirculatory perfusion.Methods: We performed a post-hoc analysis of a prospective study in septic patients who were resuscitated according a strict non-CVP guided treatment protocol. Simultaneous measurements of hemodynamics and sublingual Sidestream Dark Field imaging were obtained 0 and 30 minutes after fulfillment of resuscitation goals. Data were examined for differences in microcirculatory variables for CVP ≤ or > 12 mmHg and its evolution over time, as well as for predictors of a microvascular flow index (MFI) 12 mmHg) group as compared to patients in the 'low' CVP (≤12 mmHg) group (1.4 ± 0.9 vs. 1.9 ± 0.9, P = 0.006; and 88 ± 21% vs. 95 ± 8%, P = 0.006 respectively). Perfusion pressure (MAP-CVP) and cardiac output did not differ significantly between both CVP groups. From time point 0 to 30 minutes, a significant increase in MFI (from 1.6 ± 0.6 to 1.8 ± 0.9, P = 0.027) but not in PPV, was observed, while CVP and perfusion pressure significantly decreased in the same period. In a multivariate model CVP > 12 mmHg was the only significant predictor for a capillary MFI < 2.6 (Odds ratio 2.5 (95% confidence interval 1.1-5.8), P = 0.026).Conclusion: We observed a significant association between a higher CVP and impairment of microcirculatory blood flow. Further research is needed to elaborate on our hypothesis generating findings that an elevated CVP may act as an outflow obstruction of organ perfusion

Climate changes spatial planning : knowledge project plan

Uitgave in het kader van Programma Klimaat voor Ruimt

Paddenstoelengeslachten in het moleculair-fylogenetische tijdperk : nieuwe inzichten of nieuwlichterij?

During the last few years a large number of new mushroom genera have been described. In many cases such new genera were proposed as a consequence of molecular phylogenetic research, whereas morphological support for these genera was in a number of cases not presented. In this paper we discuss a number of these changes (boletes, the previous genus Clitocybe; in both cases a large number of new genera were proposed). We also ask the question to what extent such changes have to be followed. At the end we introduce a number of criteria that are helpful in judging whether such new genera are indeed indicative of taxonomical progress. It is clear that many of the new genera do not (yet) fulfil these criteri

&lt;I&gt;Lepiota&lt;/I&gt; (Agaricales) in northern Thailand-2 &lt;I&gt;Lepiota&lt;/I&gt; section &lt;I&gt;Lepiota&lt;/I&gt;

In this report, we investigate the presence of Lepiota species in section Lepiota in Northern Thailand (Chiang Mai and Chiang Rai). Five Lepiota species are characterised by distinct fusiform-amygdaliform spores. Of these, three species, namely L. eurysperma, L. microcarpa, and L. pongduadensis, are proposed as new species; L. metulispora is a new record for Thailand. Macro- and microscopic descriptions, illustrations, and a key to the species are provided. In addition, the identity of these Lepiota species is also clarified based on molecular data.</p