Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4 Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4 Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4 Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4 Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4 Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4
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Blanche Montagne Grosses Or La Eden soldes Brownrose Par Lumière Sommet x6wqXfg4

  • B. Vallet
  • B. Lévy
  • B. Vallet
    • 1
  • B. Lévy
    • 2
  1. 1.Pôle d’Anesthésie Réanimation Hôpital HuriezCHRU de LilleLille Cedex
  2. 2.Service de Réanimation médicaleHôpital de BraboisVandoeuvre-les-NancyConfortable Ugg Boîte Double Diamant De De Vacances Cadeau Blackfreshwater Perle 6CCqPrxwd
Part of the Le point sur ... book series (POINT)

Abstrait

Dans une situation qualifiée de « critique » (pouvant aboutir à un état de choc), le système cardiovasculaire ne peut pas apporter un débit circulatoire suffisant à chaque organe dans le but de maintenir ses fonctions métaboliques. Dans certains cas, l’organe lui-même est lésé au cours de la situation « critique » (par exemple le cerveau en neurotaumatologie), et le monitorage systémique ne permet pas à lui seul de conduire une thérapeutique efficace pour cet organe. Cet état critique peut s’observer avec un débit cardiaque bas, normal ou élevé mais toujours inadapté à l’adéquation transport-consommation d’oxygène (TO2/VO2) locale de l’organe considéré. Cette inadéquation locale est aussi appelée dysoxie: une insuffisance respiratoire cellulaire, le plus souvent secondaire à une insuffisance circulatoire aiguë, entraînant une baisse de la délivrance effective en oxygène (O2) aux tissus et provoquant une véritable crise énergétique cellulaire responsable d’un défaut de synthèse de l’adénosine triphosphate (ATP) par arrêt de fonctionnement de la phosphorylation oxydative. L’appréciation de cette inadéquation locale reste d’un accès difficile aujourd’hui pour le clinicien car il dispose de peu d’outils facilement utilisables et capables de répondre à la question suivante: existe-t-il une relation entre la dysfonction d’organe observée (en général a posteriori, c’est-à-dire après l’épisode « critique ») et le « chiffre » anormal rendu par l’outil de monitorage local lors de l’épisode « critique »?

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