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Intensive Care Medicine

, Volume 36, Issue 6, pp 949–955 | Cite as

Effects of fluids on microvascular perfusion in patients with severe sepsis

  • Gustavo Ospina-Tascon
  • Ana Paula Neves
  • Giovanna Occhipinti
  • Katia Donadello
  • Gustavo Büchele
  • Davide Simion
  • Maria-Luisa Chierego
  • Tatiana Oliveira Silva
  • Adriana Fonseca
  • Jean-Louis Vincent
  • Daniel De Backer
Original

Abstract

Purpose

To evaluate the effects of fluid administration on microcirculatory alterations in sepsis.

Methods

With a Sidestream Dark Field device, we evaluated the effects of fluids on the sublingual microcirculation in 60 patients with severe sepsis. These patients were investigated either within 24 h (early, n = 37) or more than 48 h (late, n = 23) after a diagnosis of severe sepsis. Hemodynamic and microcirculatory measurements were obtained before and 30 min after administration of 1,000 ml Ringer’s lactate (n = 29) or 400 ml 4% albumin (n = 31) solutions.

Results

Fluid administration increased perfused small vessel density from 3.5 (2.9–4.3) to 4.4 (3.7–4.9) n/mm (p < 0.01), through a combined increase in the proportion of perfused small vessels from 69 (62–76) to 79 (71–83) %, p < 0.01) and in small vessel density from 5.3 (4.4–5.9) to 5.6 (4.8–6.3) n/mm (p < 0.01). Importantly, microvascular perfusion increased in the early but not in the late phase of sepsis: the proportion of perfused small vessels increased from 65 (60–72) to 80 (75–84) % (p < 0.01) in the early phase and from 75 (66–80) to 74 (67–81) (p = ns) in the late phase. These microvascular effects of fluids were not related to changes in cardiac index (R 2 = 0.05, p = ns) or mean arterial pressure (R 2 = 0.04, p = ns).

Conclusions

In this non-randomized trial, fluid administration improved microvascular perfusion in the early but not late phase of sepsis. This effect is independent of global hemodynamic effects and of the type of solution.

Keywords

Microcirculation Cardiac output Colloids Crystalloids 

Notes

Acknowledgment

This study was supported by institutional funds only.

Supplementary material

134_2010_1843_MOESM1_ESM.doc (366 kb)
Supplementary material 1 (DOC 366 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Gustavo Ospina-Tascon
    • 1
  • Ana Paula Neves
    • 1
  • Giovanna Occhipinti
    • 1
  • Katia Donadello
    • 1
  • Gustavo Büchele
    • 1
  • Davide Simion
    • 1
  • Maria-Luisa Chierego
    • 1
  • Tatiana Oliveira Silva
    • 1
  • Adriana Fonseca
    • 1
  • Jean-Louis Vincent
    • 1
  • Daniel De Backer
    • 1
  1. 1.Department of Intensive CareErasme University Hospital, Université Libre de BruxellesBrusselsBelgium

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