Effects of fluids on microvascular perfusion in patients with severe sepsis

Ospina-Tascón, Gustavo Adolfo; Neves, Ana; Occhipinti, Giovanna; Donadello, Katia; Büchele, Gustavo Luiz; Simion, Davide; Chierego, Marialuisa; Silva, Tatiana Oliveira; Fonseca, Adriana; Vincent, Jean‐Louis; Backer, Daniel De

doi:10.1007/s00134-010-1843-3

Cited by 273 publications

(209 citation statements)

References 27 publications

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“…As a result, the sublingual microcirculation at baseline in our study seems to be less altered when compared with other studies. However, they were similar to microcirculatory parameters in resuscitated septic shock patients [11,12,22]. Considerable microcirculatory interpatient variations are reported in septic shock patients after MAP titration despite fluid resuscitation [12,26], which indicates that the level of MAP should be adapted in consideration of the interindividual effect.…”

Section: ±supporting

confidence: 55%

A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: A prospective open-label study

Yang

Qiu

2015

Journal of Critical Care

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Section: ±supporting

confidence: 55%

A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: A prospective open-label study

Yang

Qiu

2015

Journal of Critical Care

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“…Although EGDT is considered to improve microcirculation (23,24) and was associated with lower organ dysfunction-related scores, no benefit in mortality due to multiorgan failure was proven (19).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Acute Kidney Injury in Septic Shock Patients

Plataki¹,

Kashani²,

Cabello-Garza³

et al. 2011

Clinical Journal of the American Society of Nephrology

162

107

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SummaryBackground and objectives Acute kidney injury (AKI) is a frequent complication in critically ill patients and sepsis is the most common contributing factor. We aimed to determine the risk factors associated with AKI development in patients with septic shock.Design, setting, participants, & measurements Observational cohort study consisted of consecutive adults with septic shock admitted to a medical intensive care unit (ICU) of a tertiary care academic hospital from July 2005 to September 2007. AKI was defined according to RIFLE criteria (urine output and creatinine criteria). Demographic, clinical, and treatment variables were reviewed. Main outcomes measured were AKI occurrence, all-cause hospital mortality, and hospital and ICU length of stay.Results Three hundred ninety patients met inclusion criteria, of which 237 (61%) developed AKI. AKI development was independently associated with delay to initiation of adequate antibiotics, intra-abdominal sepsis, blood product transfusion, use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker, and body mass index (kg/m 2 ). Higher baseline GFR and successful early goal directed resuscitation were associated with a decreased risk of AKI. Hospital mortality was significantly greater in patients who developed AKI (49 versus 34%).Conclusions In a contemporary cohort of patients with septic shock, both patient and health care delivery risk factors seemed to be important for AKI development.

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“…5 Sidestream darkfield (SDF) imaging is available at the bedside and has been used to directly visualize sublingual capillary beds, thus far predominantly in intensive care unit (ICU) patients with septic shock. 1,[5][6][7][8][9][10] Previous studies demonstrated that observable microcirculatory flow impairment is present in patients with septic shock compared with healthy controls, and persistent impairment after resuscitation to hemodynamic endpoints is associated with increased mortality. 5,6 A prior mouse study showed that microcirculatory flow measured by SDF is markedly decreased in infected mice without hypotension, compared with hypotensive mice with induced hemorrhage.…”

mentioning

confidence: 99%

The Microcirculation Is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

Filbin

Hou

Massey

et al. 2014

Academic Emergency Medicine

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Objectives: Microcirculatory dysfunction plays an important role in sepsis pathophysiology. Previous studies using sidestream dark-field (SDF) imaging have demonstrated microcirculatory flow abnormalities in patients with septic shock; however, the microcirculation is relatively unstudied in lower-acuity sepsis patients. The hypothesis was that patients with sepsis, but without hypotension, will demonstrate signs of flow abnormalities compared to noninfected control patients.Methods: This was a prospective, observational study in a convenience sample of patients with sepsis and noninfected controls, conducted in three urban, tertiary care emergency departments (EDs) in the United States. Sepsis was defined as suspected infection plus two or more systemic inflammatory response syndrome (SIRS) criteria; those with hypotension were excluded. Noninfected controls were ED patients without infection and without SIRS criteria. SDF imaging was obtained in all study patients during ED evaluation. Recommended microcirculatory flow parameters were measured, and the difference in these measures between sepsis patients and noninfected controls were calculated. The authors also correlated microcirculatory flow parameters with patient variables, including serum lactate.Results: A total of 106 patients were enrolled: 63 with sepsis and 43 noninfected controls. There were no differences in microcirculatory flow scores between sepsis patients and noninfected controls. Median microvascular flow index (MFI; with interquartile range [IQR] was 3.00 (IQR = 2.73 to 3.00) in sepsis patients versus 2.93 (IQR = 2.73 to 3.00) in control patients (p = 0.33), and mean proportion of perfused small vessels (PPV) was 91.5% (95% CI = 89.7% to 93.3%) versus 91.8% (95% CI = 89.7% to 93.9%), with a mean difference of 0.3% (95% CI = -2.5% to 3.1%; p = 0.84). Similarly, there were no significant differences in total vessel density, perfused vessel density, or heterogeneity index (HI). In the subset of infected patients for whom serum lactates were obtained (n % 37), MFI and PPV were negatively correlated with elevated serum lactate values: r = -0.32, p = 0.04; and r = -0.44, p < 0.01, respectively.Conclusions: Measureable microcirculatory flow abnormalities were not observed in patients with early sepsis in the absence of hypotension. However, microcirculatory abnormalities were correlated with elevated serum lactate in normotensive sepsis patients, supporting the notion that impaired microcirculatory flow is coupled with cellular distress.ACADEMIC EMERGENCY MEDICINE 2014; 21:154-162

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Effects of fluids on microvascular perfusion in patients with severe sepsis

Abstract: In this non-randomized trial, fluid administration improved microvascular perfusion in the early but not late phase of sepsis. This effect is independent of global hemodynamic effects and of the type of solution.

Cited by 273 publications

References 27 publications

A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: A prospective open-label study

A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: A prospective open-label study

Predictors of Acute Kidney Injury in Septic Shock Patients

The Microcirculation Is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

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