sublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patients舌下microcirculatory变化在高容量血液滤过高动力性的脓毒性休克患者.pdfVIP

Ruiz et al. Critical Care 2010, 14:R170 /content/14/5/R170 RESEARCH Open Access Sublingual microcirculatory changes during high- volume hemofiltration in hyperdynamic septic shock patients 1 1 1 2 1 1* Carolina Ruiz , Glenn Hernandez , Cristian Godoy , Patricio Downey , Max Andresen , Alejandro Bruhn Abstract Introduction: Previous studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients. However, arterial pressure stabilization occurs due to an increase in systemic vascular resistance, which could eventually compromise microcirculatory blood flow and perfusion. The goal of this study was to determine if HVHF deteriorates sublingual microcirculation in severe hyperdynamic septic shock patients. Methods: This was a prospective, non-randomized study at a 16-bed, medical-surgical intensive care unit of a university hospital. We included 12 severe hyperdynamic septic shock patients (norepinephrine requirements 0.3 μg/ kg/min and cardiac index 3.0 L/min/m2) who underwent a 12-hour HVHF as a rescue therapy according to a predefined algorithm. Sublingual microcirculation (Microscan for NTSC, Microvision Medical), systemic hemodynamics and perfusion parameters were assessed at baseline, at 12 hours of HVHF, and 6 hours after stopping HVHF. Results: Microcirculatory flow index increased after 12 hours of HVHF and this increase persisted 6 hours after stopping HVHF. A similar trend was observed for the proportion of perfused microvessels. The increase in microcirculatory blood flow was inversely correlated with baseline levels. There was no significant change in microvascular density or heterogeneity during or afte