The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects*

Backer, Daniel De; Créteur, Jacques; Dubois, Marc-Jacques; Sakr, Yasser; Koch, Marc; Verdant, Colin; Vincent, Jean‐Louis

doi:10.1097/01.ccm.0000198107.61493.5a

Cited by 432 publications

(280 citation statements)

References 33 publications

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“…In an openlabel setting addition of dobutamine in septic patients was associated with improved OPS-measured sublingual microcirculatory perfusion over time, irrespective of changes in systemic hemodynamic variables [66]. Interestingly, topical application of acetylcholine further improved microcirculatory perfusion, challenging the widespread concept of an irresponsive endothelium in sepsis-induced hypotension.…”

Section: Vasopressorsmentioning

confidence: 97%

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Boerma

İnce

2012

Applied Physiology in Intensive Care Medicine 2

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Section: Vasopressorsmentioning

confidence: 97%

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Boerma

İnce

2012

Applied Physiology in Intensive Care Medicine 2

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“…James et al (1999), descreveram aumento da produção de lactato quando referiram que a liberação da adrenalina endógena promove o aumento da glicólise aeróbica, em virtude de estimular a bomba de Na+/-K ATPase celular. Além disso, a contenção física dos cães e a oclusão venosa realizada para a cateterização podem sugerir a elevação discreta do lactato sérico, devido ao aumento na atividade muscular e a lise eritrocitária (Hughes 2000, De Backer et al 2006; sistemas responsá- veis por 20 a 25% da produção do lactato sérico fisiológico orgânico (Okorie & Dellinger 2011). Fatores psicológicos, como a ansiedade, podem estar envolvidos no aumento do lactato sérico, como descreveram Rocha et al (2009) quando identificaram o aumento na concentração de lactato sérico e cortisol basal em atletas antes de uma prova de atletismo, justificando o aumento na liberação de catecolaminas e mobilização de energia orgânica como responsá-veis para o aumento do lactato sérico.…”

Section: Discussionunclassified

Valores de lactato sérico e sua correlação com parâmetros clínicos de cães saudáveis, mensurados durante atendimento ambulatorial veterinário

et al. 2016

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ABSTRACT.-Franco R.P., Massufaro C.R., Martineli J., Girotto C.H., Hirota I.N., Zache E. & Hataka A. 2016 The measurement of serum lactate is used in the medical routine as a prognosis marker of emergency patients. Its interpretation should not be done disconnectedly from the other clinical parameters once metabolical or environmental stress as well as restraint and/or manipulation of patients can interfere. Thus we tried to measure the levels of serum lactate and clinical parameters of healthy dogs, as their correlation during veterinarian outpatient clinical care. For that we evaluated 80 dogs, males and females, with age ranging from one to eight years, met for polyvalent annual revaccination. We considered to be healthy those dogs that had no clinical events in the last 60 days or alteration in physical exams, blood exam values and serum glycemia. We initially measured body weight, heart rate (HR) and respiratory (RR), capillary refill time, mucosa's coloring, rectal temperature (RT), peripheral temperature (PT) and the difference between RT and PT, Delta T°C. Finally we did the blood exam and the serum glycemia, as well as the serum lactate measurement. For that we used a portable lactimeter, using the blood sample taken from the cephalic vein. Furthermore, when there was correlation between the serum lactate values and the body weight, we divided the dogs according to the calculation of 33 and 66 percentile. Evaluated dogs showed average values of 18.3±12.1 kg of body weight and 3.0±1.9 of age; with HR of 126.6±29.1bpm, RR of 66±24mpm, RT of 38.9±0.4°C, PT of 31.5±1,0°C, Delta T°C of 7.3±1.0°C and serum lactate of 3.2±0.4mmol/L; with the latter showing range of 3.1-3.3mmol/L with 95% of reliability and significant correlation (p<0.05) between its values and the body weight (r=0.6) and the heart rate (r=0.4). The serum lactate values obtained were compared between the dogs' groups according to their body weight, showing distinguished differences between them. Thereby we concluded that the serum lactate values in dogs under outpatient care is 3.2mmol/L, with a trust gap of 3.1-3.3mmol/L, highlighting the influence that HR and body weight can have on its values.INDEX TERMS: Serum lactate, clinical parameters, dogs.

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“…The effects of capillary flow patterns on tissue oxygenation re‐emphasizes the microcirculation as a potential target of therapy in critical illness, either through active control of capillary and arteriolar tone, by maintenance of appropriate blood viscosity, or by protection of the endothelium 60, 61, 62, 63. The prevention of mitochondrial injury, however, remains a crucial goal: Pathological redistribution of capillary flows exposes some cells to oxygen in excess of their metabolic needs while others are deprived of oxygen – both of which are associated with mitochondrial reactive oxygen species production and the initiation of apoptotic pathways 64…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Microcirculatory dysfunction and tissue oxygenation in critical illness

Østergaard

Granfeldt

Secher

et al. 2015

Acta Anaesthesiol Scand

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Severe sepsis is defined by organ failure, often of the kidneys, heart, and brain. It has been proposed that inadequate delivery of oxygen, or insufficient extraction of oxygen in tissue, may explain organ failure. Despite adequate maintenance of systemic oxygen delivery in septic patients, their morbidity and mortality remain high.The assumption that tissue oxygenation can be preserved by maintaining its blood supply follows from physiological models that only apply to tissue with uniformly perfused capillaries. In sepsis, the microcirculation is profoundly disturbed, and the blood supply of individual organs may therefore no longer reflect their access to oxygen.We review how capillary flow patterns affect oxygen extraction efficacy in tissue, and how the regulation of tissue blood flow must be adjusted to meet the metabolic needs of the tissue as capillary flows become disturbed as observed in critical illness. Using the brain, heart, and kidney as examples, we discuss whether disturbed capillary flow patterns might explain the apparent mismatch between organ blood flow and organ function in sepsis. Finally, we discuss diagnostic means of detecting capillary flow disturbance in animal models and in critically ill patients, and address therapeutic strategies that might improve tissue oxygenation by modifying capillary flow patterns.

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The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects*

Abstract: The administration of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock. These changes are independent of changes in systemic hemodynamic variables.

Cited by 432 publications

References 33 publications

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Valores de lactato sérico e sua correlação com parâmetros clínicos de cães saudáveis, mensurados durante atendimento ambulatorial veterinário

Microcirculatory dysfunction and tissue oxygenation in critical illness

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