| Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: a double-blind randomized placebo controlled trial. | |
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MedLine Citation:
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PMID: 19730258 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Microcirculatory alterations have been associated with morbidity and mortality in human sepsis. Such alterations occur despite pressure-guided resuscitation. Earlier data suggested that impaired microcirculatory blood flow could be corrected with intravenous nitroglycerin in these patients. We tested this concept after fulfillment of preset systemic hemodynamic resuscitation end points in the early phase of sepsis. DESIGN: Prospective, single center, randomized, placebo-controlled, double-blind clinical trial. SETTING: Closed-format 22-bed mixed intensive care unit in a tertiary teaching hospital. PATIENTS: Patients > or =18 yrs with sepsis, according to international criteria, and at least one early sign of organ dysfunction, as the principal reason for intensive care unit admission, were eligible for enrollment. INTERVENTIONS: Patients were randomly assigned to receive nitroglycerin (n = 35) or placebo (n = 35) after fulfillment of protocol-driven resuscitation end points. This trial is registered with ClinicalTrials.gov as NCT00493415. MEASUREMENTS AND MAIN RESULTS: Primary outcome was sublingual microcirculatory blood flow of small vessels, as assessed by side-stream dark field imaging. After protocolized resuscitation, we observed recruitment of sublingual microcirculation in both groups, as indicated by a significant improvement in the microcirculatory flow index after 24 hrs, in comparison to baseline. However, no difference in the sublingual microvascular flow index was observed between groups. The median microvascular flow index in sublingual small-sized vessels was 2.71 (1.85-3) in the nitroglycerin group and 2.71 (1.27-3), p = .80, in the placebo group. In medium-sized vessels, the respective values were 3 (2.75-3) vs. 2.86 (2.19-3), p = .21, and in large-sized vessels, 3 (3-3) vs. 3 (2.89-3), p = .06. In-hospital mortality, as a secondary outcome, was 34.3% in the nitroglycerin group and 14.2% in the placebo group, p = .09. CONCLUSIONS: In the context of a strict resuscitation protocol, based upon fulfillment of systemic hemodynamic end points in patients with early-phase severe sepsis or septic shock, we conclude that intravenous nitroglycerin does not promote sublingual microcirculatory blood flow. |
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Authors:
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E Christiaan Boerma; Matty Koopmans; Arjan Konijn; Katerina Kaiferova; Andries J Bakker; Eric N van Roon; Hanneke Buter; Nienke Bruins; Peter H Egbers; Rik T Gerritsen; Peter M Koetsier; W Peter Kingma; Michael A Kuiper; Can Ince |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2009-12-22 Completed Date: 2010-01-15 Revised Date: 2010-01-20 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 93-100 Citation Subset: AIM; IM |
Affiliation:
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Department of Translational Physiology (ECB, CI), Academic Medical Centre, Amsterdam, The Netherlands. e.boerma@chello.nl |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00493415 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Sublingual Adult Aged Blood Flow Velocity / drug effects Cause of Death* Dose-Response Relationship, Drug Double-Blind Method Drug Administration Schedule Female Follow-Up Studies Hemodynamics / drug effects, physiology Hospital Mortality / trends* Hospitals, Teaching Humans Intensive Care / methods Intensive Care Units Male Microcirculation / drug effects Middle Aged Nitroglycerin / administration & dosage* Probability Reference Values Resuscitation / methods* Risk Assessment Sepsis / diagnosis, drug therapy, mortality, therapy Shock, Septic / diagnosis, drug therapy*, mortality*, therapy Survival Analysis Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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55-63-0/Nitroglycerin |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Feb;38(2):737-8; author reply 738
[PMID:
20083957
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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