Professional Documents
Culture Documents
he signicance of persistent
occult hypoperfusion in the
development of multiple system organ failure and death
has been described and, no doubt, needs
further elucidation.
Visible hypoperfusion, either as shock
or as hypotension, and visible hypovolemia have been treated actively in critically ill patients during the past decades
to decrease the incidence of multiple organ dysfunction syndrome (MODS), although not always with great success (1).
Therefore, an increasing number of researchers have proposed a role for occult
hypoperfusion in the pathophysiology of
MODS, especially in those cases where
visible hypoperfusion has been treated
correctly (2).
Occult hypoperfusion has been associated with an increased mortality rate despite the normalization of visible hypoperfusion (2, 3). It is well known that
MODS, an important cause of morbidity
and mortality, occurs despite correction
of visible hypoperfusion in many conditions, including sepsis (4) and systemic
inammatory response syndrome induced by multiple trauma, burns, severe
acute pancreatitis, bypass, and other conditions (5). Blood lactate level has been
associated with the occurrence of organ
failure using several organ failure scales
and is potentially a reliable marker of
persistent occult hypoperfusion (6). Nevertheless, the relationship between lactate levels and the Sequential Organ Failure Assessment (SOFA) score (7) has not
been studied until now, particularly in
occult hypoperfusion.
In this issue of Critical Care Medicine,
Jansen and colleagues (8) hypothesize
2478
REFERENCES
1. Nguyen HB, Rivers EP, Knoblich BP, et al:
Early lactate clearance is associated with improved outcome in severe sepsis and septic
shock. Crit Care Med 2004; 32:16371642
2. Howell MD, Donnino M, Clardy P, et al: Occult hypoperfusion and mortality in patients
with suspected infection. Intensive Care Med
2007; 33:18921899
3. Meregalli A, Oliveira RP, Friedman G: Occult
hypoperfusion is associated with increased
mortality in hemodynamically stable, high
risk, surgical patients. Crit Care 2004;
8:60 65
4. OBrien JM Jr, Ali NA, Abraham E: Year in
review 2007: Critical caremultiple organ
failure and sepsis. Crit Care 2008; 12:228
5. Durham RM, Moran JJ, Mazuski JE, et al:
Multiple organ failure in trauma patients.
J Trauma 2003; 55:608 616
6. Bakker J, Gris P, Coffernils M, et al: Serial
blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996; 171:221226
7. Vincent JL, Moreno R, Takala J, et al: The
SOFA (Sepsis-related Organ Failure Assess-
8.
9.
10.
11.
12.
13.
14.
15.
16.