| Effects of fluids on microvascular perfusion in patients with severe sepsis. | |
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MedLine Citation:
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PMID: 20221744 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2010-03-11 |
Journal Detail:
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Title: Intensive care medicine Volume: 36 ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-06 Completed Date: 2010-09-08 Revised Date: 2010-10-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 949-55 Citation Subset: IM |
Affiliation:
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Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Albumins / administration & dosage, metabolism Cardiac Output Female Fluid Therapy / methods* Hemodynamics / physiology Humans Isotonic Solutions / administration & dosage, metabolism Male Microcirculation / drug effects, physiology* Middle Aged Perfusion* Sepsis / physiopathology* Severity of Illness Index* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Albumins; 0/Isotonic Solutions; 8022-63-7/Ringer's lactate |
| Comments/Corrections | |
Comment In:
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Intensive Care Med. 2010 Nov;36(11):1807-9
[PMID:
20725822
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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