PURPOSE: Fluid therapy is a cornerstone in the management of severe sepsis but its microcirculatory effects are not well defined. Experimental data suggest that colloids may better preserve the microcirculation than crystalloids, but these data have been usually obtained during severe hemodilution. We evaluated the effects of crystalloids and albumin administration on microcirculatory alterations in patients with severe sepsis.
METHODS: We used a Sidestream Dark-Field (SDF) imaging device (Microvision Medical, Amsterdam, The Netherlands) to evaluate the sublingual microcirculation in 55 patients with severe sepsis. Hemodynamic and microcirculatory measurements were obtained before and after fluid challenge with 400 ml of 4% albumin (n=27) or 1000 ml of crystalloids (either NaCL 0.9 % or Ringer's lactate, n=28). At each time, 5 sequences of 20 seconds each were recorded and stored under a random number. An investigator blinded to the patient's clinical course and sequences order, analyzed the images semi-quantitatively. The proportion of perfused small vessels (smaller than 20 micrometer in diameter, representing mostly capillaries) was evaluated. Statistical evaluation was performed using ANOVA. A p value <0.05 was considered to be significant.
RESULTS: There was no significant difference at baseline in arterial pressure and cardiac index with both types of fluids. The evolution in these variables was similar with both types of fluids (ANOVA Group × time p>0.05). The proportion of perfused capillaries increased significantly with crystalloids (from 66 ± 11 to 76 ± 10%, p<0.01) and with albumin (from 69 ± 9 to 77 ± 12 %, p<0.01), but these changes were similar with both types of fluids (ANOVA group × time p>0.05).
CONCLUSION: Fluid administration can improve the microcirculation in severe sepsis but the type of fluid, crystalloid or albumin, does not influence this response.
CLINICAL IMPLICATIONS: Either crystalloids or colloids can be used to improve tissue perfusion in patients with severe sepsis.
DISCLOSURE: Daniel De Backer, No Financial Disclosure Information; No Product/Research Disclosure Information