Sublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patients

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dc.contributor.authorRuiz, Carolina
dc.contributor.authorHernández P., Glenn
dc.contributor.authorGodoy, Cristián
dc.contributor.authorDowney Concha, Patricio
dc.contributor.authorAndresen Hernández, Max
dc.contributor.authorBruhn, Alejandro
dc.date.accessioned2019-10-17T10:58:53Z
dc.date.available2019-10-17T10:58:53Z
dc.date.issued2010
dc.date.updated2019-10-14T19:04:26Z
dc.description.abstractAbstract Introduction Previous studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients. However, arterial pressure stabilization occurs due to an increase in systemic vascular resistance, which could eventually compromise microcirculatory blood flow and perfusion. The goal of this study was to determine if HVHF deteriorates sublingual microcirculation in severe hyperdynamic septic shock patients. Methods This was a prospective, non-randomized study at a 16-bed, medical-surgical intensive care unit of a university hospital. We included 12 severe hyperdynamic septic shock patients (norepinephrine requirements > 0.3 μg/kg/min and cardiac index > 3.0 L/min/m2) who underwent a 12-hour HVHF as a rescue therapy according to a predefined algorithm. Sublingual microcirculation (Microscan for NTSC, Microvision Medical), systemic hemodynamics and perfusion parameters were assessed at baseline, at 12 hours of HVHF, and 6 hours after stopping HVHF. Results Microcirculatory flow index increased after 12 hours of HVHF and this increase persisted 6 hours after stopping HVHF. A similar trend was observed for the proportion of perfused microvessels. The increase in microcirculatory blood flow was inversely correlated with baseline levels. There was no significant change in microvascular density or heterogeneity during or after HVHF. Mean arterial pressure and systemic vascular resistance increased while lactate levels decreased after the 12-hour HVHF. Conclusions The use of HVHF as a rescue therapy in patients with severe hyperdynamic septic shock does not deteriorate sublingual microcirculatory blood flow despite the increase in systemic vascular resistance.Abstract Introduction Previous studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients. However, arterial pressure stabilization occurs due to an increase in systemic vascular resistance, which could eventually compromise microcirculatory blood flow and perfusion. The goal of this study was to determine if HVHF deteriorates sublingual microcirculation in severe hyperdynamic septic shock patients. Methods This was a prospective, non-randomized study at a 16-bed, medical-surgical intensive care unit of a university hospital. We included 12 severe hyperdynamic septic shock patients (norepinephrine requirements > 0.3 μg/kg/min and cardiac index > 3.0 L/min/m2) who underwent a 12-hour HVHF as a rescue therapy according to a predefined algorithm. Sublingual microcirculation (Microscan for NTSC, Microvision Medical), systemic hemodynamics and perfusion parameters were assessed at baseline, at 12 hours of HVHF, and 6 hours after stopping HVHF. Results Microcirculatory flow index increased after 12 hours of HVHF and this increase persisted 6 hours after stopping HVHF. A similar trend was observed for the proportion of perfused microvessels. The increase in microcirculatory blood flow was inversely correlated with baseline levels. There was no significant change in microvascular density or heterogeneity during or after HVHF. Mean arterial pressure and systemic vascular resistance increased while lactate levels decreased after the 12-hour HVHF. Conclusions The use of HVHF as a rescue therapy in patients with severe hyperdynamic septic shock does not deteriorate sublingual microcirculatory blood flow despite the increase in systemic vascular resistance.
dc.fuente.origenBiomed Central
dc.identifier.citationCritical Care. 2010 Sep 27;14(5):R170
dc.identifier.doi10.1186/cc9271
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/26579
dc.issue.numeroNo. R170
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final9
dc.pagina.inicio1
dc.revistaCritical Carees_ES
dc.rightsacceso abierto
dc.rights.holderRuiz et al.; licensee BioMed Central Ltd.
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.otherShock séptico - Terapiaes_ES
dc.subject.otherHemofiltraciónes_ES
dc.subject.otherPresion arteriales_ES
dc.titleSublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patientses_ES
dc.typeartículo
dc.volumenVol. 14
sipa.codpersvinculados98874
sipa.codpersvinculados68164
sipa.codpersvinculados54274
sipa.codpersvinculados741
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