Effects of fluids on microvascular perfusion in patients with severe sepsis
- 1.7k Downloads
To evaluate the effects of fluid administration on microcirculatory alterations in sepsis.
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.
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).
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.
KeywordsMicrocirculation Cardiac output Colloids Crystalloids
This study was supported by institutional funds only.
- 7.Trzeciak S, Dellinger RP, Parrillo JE, Guglielmi M, Bajaj J, Abate NL, Arnold RC, Colilla S, Zanotti S, Hollenberg SM (2007) Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med 49:88–98CrossRefPubMedGoogle Scholar
- 8.Trzeciak S, McCoy JV, Phillip DR, Arnold RC, Rizzuto M, Abate NL, Shapiro NI, Parrillo JE, Hollenberg SM (2008) Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med 34:2210–2217CrossRefPubMedGoogle Scholar
- 18.Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139CrossRefPubMedGoogle Scholar
- 19.Vincent J-L, Weil MH (2006) Fluid challenge revisited. Crit Care Med 34:1337Google Scholar
- 23.van der Heijden M, Verheij J, van Nieuw Amerongen GP, Groeneveld AB (2009) Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Crit Care Med 37:1275–1281Google Scholar
- 27.Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34:17–60CrossRefPubMedGoogle Scholar