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Microcirculatory Alterations Are Independent of Systemic Hemodynamics in Severe Sepsis FREE TO VIEW

Daniel De Backer*, MD; Katia Donadello, MD; Gustavo Ospina-Tascon, MD; Diego Orbegozo Cortes, MD; Diamantino Salgado, MD; Sabino Scolletta, MD; Jean-Louis Vincent, MD
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Erasme University Hospital, Brussels, Belgium

Chest. 2012;142(4_MeetingAbstracts):409A. doi:10.1378/chest.1388986
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SESSION TYPE: Sepsis/Shock Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Microcirculatory alterations are frequently observed in patients with severe sepsis and are associated with a poor outcome. However, the relationship of microcirculatory alterations with systemic variables, and in particular perfusion pressure, is not well determined. We evaluated in a large cohort of patients with severe sepsis the relationship between sublingual microcirculation and systemic hemodynamics.

METHODS: We used a Sidestream Dark-Field (SDF) imaging device (Microvision Medical, Amsterdam, The Netherlands) to evaluate the sublingual microcirculation in 203 patients with severe sepsis. Hemodynamic and microcirculatory measurements were obtained within 24 h of admission to the ICU. Five 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 capillaries (defined as vessels smaller than 20 μm in diameter) was evaluated. Perfusion pressure was computed as mean arterial pressure (MAP) minus central venous pressure (CVP). Patients were grouped according to quartiles of MAP, CVP, cardiac index (CI), and driving pressure. Statistical evaluation included ANOVA with Bonferroni correction for post hoc comparisons. A p value <0.05 was considered to be significant.

RESULTS: A wide range of MAP and perfusion pressure was covered (from 48 to 103 and from 33 to 89 mmHg, respectively) The proportion of perfused capillaries did not differ across the quartiles of MAP (Q1 ≤65 mmHg: 57.8 ± 19.9%, Q2 65-70 mmHg: 59.8 ± 14.8%; Q3 70-76.7 mmHg: 59.7 ± 17.8%; Q4 >76.7: 60.0 ± 17.0%; P=NS) and perfusion pressure (Q1 <51 mmHg: 58.2 ± 18.5%; Q2 51-57 mmHg: 59.9 ± 17.6%; Q3 57-66 mmHg: 58.0 ± 15.6%; Q4 >66 mmHg: 60.4 ± 17.5%; P=NS).

CONCLUSIONS: These results suggest that microcirculatory perfusion is minimally affected by systemic hemodynamics.

CLINICAL IMPLICATIONS: Microcirculatory alterations can be observed even when systemic hemodynamic variables are normalized or within satisfactory resuscitation goals

DISCLOSURE: The following authors have nothing to disclose: Daniel De Backer, Katia Donadello, Gustavo Ospina-Tascon, Diego Orbegozo Cortes, Diamantino Salgado, Sabino Scolletta, Jean-Louis Vincent

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Erasme University Hospital, Brussels, Belgium




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