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

Abstract

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients Boerma, C.; Ince, C.

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

“…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. In this study, titration to a pressure closer to that of a given patient's baseline aimed to reduce the interindividual variability, and reveals the microcirculatory alterations after MAP titration to a higher level in septic shock patients with previous hypertension.…”

Norepinephrine infusion increases urine output in children under sedative and analgesic infusion

“…1,2,4,5,7 This microvascular derangement can induce increased endothelial permeability, heterogeneity of blood flow and tissue hypoxia, which will lead to fluid retention, edema and oliguria -frequently observed in children requiring MV and sedative and analgesic infusions. 1,2,10,16 In this re- . a-The vasopressor score was calculated without considering the infused solution (placebo or norepinephrine).…”

“…8,9 Small arterioles are the principal site of active diameter changes (resistance vessels) to achieve regulation of capillary blood flow. 10 Vasoplegia induced by sedative and analgesic drugs decreases the flow regulatory capacity of the arterioles; consequently, the mean capillary pressure is much closer to the venous pressure than to the arterial pressure, which is crucial for the maintenance of tissue perfusion. 10,17 Considering the effects of sedative and analgesic drugs on the capillary flow, the early administration of a vasopressor agent could restore the tissue pressure perfusion and maintain cell metabolism.…”

“…10,11,12,16,18,20,21,22 Norepinephrine is the most common vasopressor drug used in septic shock to maintain mean arterial pressure (MAP). 10,11,12,16,[20][21][22][23][24] In the presence of microvascular derangement, volume resuscitation alone is not sufficient to restore and maintain mean arterial pressure despite improvement in the aortic blood flow. Use of early norepinephrine infusion, however, can restore mean arterial pressure.…”

“…The improvement in systemic circulation would impact on clinical and laboratorial parameters, such as urine output, creatinine serum levels, blood lactate, free water deficit, and excreted sodium fraction. [10][11][12] Despite norepinephrine being recommended in the treatment of pediatric septic shock, there are scarce studies evaluating the effects of this vasoactive drug in children. 8,9,13 The aim of this pilot study was to evaluate the hemodynamic response and the impact on urine output of an early norepinephrine infusion in a group of children submitted to MV, receiving usual doses of IV sedative and analgesic drug infusions (morphine/fentanyl plus midazolam).…”