Document Detail

Effects of fluids on microvascular perfusion in patients with severe sepsis.
MedLine Citation:
PMID:  20221744     Owner:  NLM     Status:  MEDLINE    
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.
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
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Publication Detail:
Type:  Journal Article     Date:  2010-03-11
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-09-08     Revised Date:  2012-05-30    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  949-55     Citation Subset:  IM    
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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MeSH Terms
Albumins / administration & dosage,  metabolism
Cardiac Output
Fluid Therapy / methods*
Hemodynamics / physiology
Isotonic Solutions / administration & dosage,  metabolism
Microcirculation / drug effects,  physiology*
Middle Aged
Mouth Floor / blood supply*
Sepsis / physiopathology*
Severity of Illness Index*
Treatment Outcome
Reg. No./Substance:
0/Albumins; 0/Isotonic Solutions; 8022-63-7/Ringer's lactate
Comment In:
Intensive Care Med. 2010 Nov;36(11):1807-9   [PMID:  20725822 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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