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01.12.2008 | Original

Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis

verfasst von: Stephen Trzeciak, Jonathan V. McCoy, R. Phillip Dellinger, Ryan C. Arnold, Michael Rizzuto, Nicole L. Abate, Nathan I. Shapiro, Joseph E. Parrillo, Steven M. Hollenberg, on behalf of the Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators

Erschienen in: Intensive Care Medicine | Ausgabe 12/2008

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Abstract

Objective

Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculatory blood flow is thought to be pivotal in the pathogenesis of sepsis-induced organ failure. We hypothesized that changes in microcirculatory flow during resuscitation are associated with changes in organ failure over the first 24 h of sepsis therapy.

Design

Prospective observational study.

Setting

Emergency Department and Intensive Care Unit.

Participants

Septic patients with systolic blood pressure <90 mmHg despite intravenous fluids or lactate ≥4.0 mM/L treated with early goal-directed therapy (EGDT).

Measurements and results

We performed Sidestream Dark Field (SDF) videomicroscopy of the sublingual microcirculation <3 h from EGDT initiation and again within a 3–6 h time window after initial. We imaged five sites and determined the mean microcirculatory flow index (MFI) (0 no flow to 3 normal) blinded to all clinical data. We calculated the Sequential Organ Failure Assessment (SOFA) score at 0 and 24 h, and defined improved SOFA a priori as a decrease ≥2 points. Of 33 subjects; 48% improved SOFA over 0–24 h. Age, APACHE II, and global hemodynamics did not differ significantly between organ failure groups. Among SOFA improvers, 88% increased MFI during EGDT, compared to 47% for non-improvers (P = 0.03). Median change in MFI was 0.23 for SOFA improvers versus −0.05 for non-improvers (P = 0.04).

Conclusions

Increased microcirculatory flow during resuscitation was associated with reduced organ failure at 24 h without substantial differences in global hemodynamics. These data support the hypothesis that targeting the microcirculation distinct from the macrocirculation could potentially improve organ failure in sepsis.

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Titel: Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis
verfasst von: Stephen Trzeciak
Jonathan V. McCoy
R. Phillip Dellinger
Ryan C. Arnold
Michael Rizzuto
Nicole L. Abate
Nathan I. Shapiro
Joseph E. Parrillo
Steven M. Hollenberg
on behalf of the Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators
Publikationsdatum: 01.12.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 12/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1193-6

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Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis