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Intensive Care Medicine

, Volume 36, Issue 11, pp 1867–1874 | Cite as

Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients

  • Julien Pottecher
  • Stéphane Deruddre
  • Jean-Louis Teboul
  • Jean-François Georger
  • Christian Laplace
  • Dan Benhamou
  • Eric Vicaut
  • Jacques DuranteauEmail author
Original

Abstract

Purpose

To assess sublingual microcirculatory changes following passive leg raising (PLR) and volume expansion (VE) in septic patients.

Methods

This prospective study was conducted in two university hospital intensive care units and included 25 mechanically ventilated patients with severe sepsis or septic shock who were eligible for VE in the first 24 h of their admission. Pulse pressure variation (ΔPP), cardiac output (CO) and sublingual microcirculation indices were assessed at five consecutive steps: (1) semi-recumbent position (Baseline 1), (2) during PLR manoeuvre (PLR), (3) after returning to semi-recumbent position (Baseline 2), (4) at the time when VE induced the same degree of preload responsiveness as PLR (VE∆PP = PLR) and (5) at the end of VE (VEEND). At each step, five sublingual microcirculation sequences were acquired using sidestream darkfield imaging to assess functional capillary density (FCD), microcirculatory flow index (MFI), proportion of perfused vessels (PPV) and flow heterogeneity index (FHI).

Results

The PLR, VE∆PP = PLR and VEEND induced a significant increase in CO and a significant decrease in ΔPP compared to Baseline 1 and Baseline 2 values. Both PLR and VE induced significant increases in FCD, MFI and PPV and a significant decrease in FHI compared to Baseline 1 and Baseline 2 values.

Conclusions

In preload responsive severe septic patients examined within the first 24 h of their admission, both PLR and VE improved sublingual microcirculatory perfusion. At the level of volume infusion used in this study, these changes in sublingual microcirculation were not explained by changes in rheologic factors or changes in arterial pressure.

Keywords

Microcirculation Sepsis Shock Volume expansion Fluid responsiveness Passive leg raising 

Notes

Acknowledgments

We are greatly indebted to Mr Nicolas Sandri, computer engineer, for his extensive software knowledge and invaluable technical assistance. Financial supports used for the study only included institutional departmental funds.

Supplementary material

134_2010_1966_MOESM1_ESM.doc (493 kb)
Supplementary material 1 (DOC 493 kb)

Supplementary Animation 1 (MPG 7608 kb)

Supplementary Animation 2 (MPG 5984 kb)

Supplementary Animation 3 (MPG 7428 kb)

Supplementary Animation 4 (MPG 4122 kb)

Supplementary Animation 5 (MPG 5454 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Julien Pottecher
    • 1
  • Stéphane Deruddre
    • 1
  • Jean-Louis Teboul
    • 2
  • Jean-François Georger
    • 2
  • Christian Laplace
    • 1
  • Dan Benhamou
    • 1
  • Eric Vicaut
    • 3
  • Jacques Duranteau
    • 1
    Email author
  1. 1.Unité EA 3509, Département d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique Hôpitaux de Paris Université Paris 11Le Kremlin-Bicêtre CedexFrance
  2. 2.EA 4046, Service de Réanimation Médicale, Centre Hospitalier Universitaire de Bicêtre, AP-HP Université Paris 11Le Kremlin-Bicêtre CedexFrance
  3. 3.EA 3509, Laboratoire d’Etude de la Microcirculation, Unité de Recherche Clinique, Centre Hospitalier Universitaire Lariboisière–Fernand Widal, AP-HPUniversité Paris 7ParisFrance

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