Influence of systemic hemodynamics on microcirculation during sepsis

Magalie Collet; Benjamin Huot; Romain Barthélémy; Charles Damoisel; Didier Payen; Alexandre Mebazaa; Benjamin G Chousterman

doi:10.1016/j.jcrc.2019.05.002

Influence of systemic hemodynamics on microcirculation during sepsis

J Crit Care. 2019 Aug:52:213-218. doi: 10.1016/j.jcrc.2019.05.002. Epub 2019 May 6.

Authors

Magalie Collet¹, Benjamin Huot², Romain Barthélémy², Charles Damoisel², Didier Payen³, Alexandre Mebazaa⁴, Benjamin G Chousterman⁵

Affiliations

¹ Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
² Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
³ Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
⁴ Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U942, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
⁵ Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France. Electronic address: Benjamin.huot@aphp.fr.

PMID: 31102939
DOI: 10.1016/j.jcrc.2019.05.002

Abstract

Purpose: During sepsis, improvement of hemodynamic may not be related to improvement of microcirculation. The aim of this study was to investigate influence of systemic circulation on microcirculation in septic ICU patients.

Methods: This is a prospective cohort study of septic ICU patients. Microcirculation was investigated with Near infrared spectrometry (NIRS) measuring tissue oxygen saturation (StO₂). StO₂ desaturation (desStO₂) and resaturation (resStO₂) slopes were determined. Analyses were made at baseline and after fluid challenges.

Results: Seventy-two patients were included. One hundred and sixty measures were performed at baseline. StO₂ was 77.8% [72.4-85.0] and resStO₂ was 87.3%/min [57.8-141.7]. Univariate analysis showed an association between resStO₂ and diastolic arterial pressure (DAP) (p = .001), and norepinephrine dose (p = .033). In multivariate linear regression, there was an association between resStO₂ and DAP (β = 1.85 (0.64 to 3.08), p = .004)_. Fluid challenges (n = 60) increased CO, and resStO₂ (all p < .001). In multivariate analysis, variation of stroke volume was associated with variation of resStO₂ (p = .004) after fluid challenge. There was no association between CVP and resStO₂.

Conclusions: DAP was the only independent determinant of resStO2 in septic patients. Fluid challenges may improve microcirculation. CVP did not influence resStO₂.

Keywords: Fluid challenge; Hemodynamic; Microcirculation; Sepsis; StO(2).

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Critical Care
Female
Fluid Therapy / methods
Hemodynamics / physiology
Humans
Male
Microcirculation / physiology*
Middle Aged
Norepinephrine / pharmacology
Prospective Studies
Ringer's Lactate / administration & dosage
Ringer's Lactate / pharmacology
Sepsis / physiopathology*
Spectroscopy, Near-Infrared / methods
Vasoconstrictor Agents / pharmacology

Substances

Ringer's Lactate
Vasoconstrictor Agents
Norepinephrine