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. 2011 Jun 14:11:12.
doi: 10.1186/1471-2253-11-12.

Microcirculatory changes during open label magnesium sulphate infusion in patients with severe sepsis and septic shock

Andrius Pranskunas  1 , Namkje Ar Vellinga, Vidas Pilvinis, Matty Koopmans, E Christiaan Boerma
Affiliations

Microcirculatory changes during open label magnesium sulphate infusion in patients with severe sepsis and septic shock

Andrius Pranskunas et al. BMC Anesthesiol. .

Abstract

Background: Microcirculatory alterations play a pivotal role in sepsis and persist despite correction of systemic hemodynamic parameters. Therefore it seems tempting to test specific pro-microcirculatory strategies, including vasodilators, to attenuate impaired organ perfusion. As opposed to nitric oxide donors, magnesium has both endothelium-dependent and non-endothelium-dependent vasodilatory pathways.

Methods: In a single-center open label study we evaluated the effects of magnesium sulphate (MgS) infusion on the sublingual microcirculation perfusion in fluid resuscitated patients with severe sepsis and septic shock within the first 48 hours after ICU admission. Directly prior to and after 1 hour of magnesium sulphate (MgS) infusion (2 gram) systemic hemodynamic variables, sublingual SDF images and standard laboratory tests, were obtained.

Results: Fourteen patients (12 septic shock, 2 severe sepsis) with a median APACHE II score of 20 were enrolled. No significant difference of the systemic hemodynamic variables was found between baseline and after MgS infusion. We did not observe any significant difference pre and post MgS infusion in the primary endpoint microvascular flow index (MFI) of small vessels: 2.25(1.98-2.69) vs. 2.33(1.96-2.62), p = 0.65. Other variables of microcirculatory perfusion were also unaltered. In the overall unchanged microvascular perfusion there was a non-significant trend to an inverse linear relationship between the changes of MFI and its baseline value (y = -0.7260 × + 1.629, r2 = 0.270, p = 0.057). The correlation between baseline Mg concentrations and the change in MFI pre- and post MgS infusion was non-significant (rs = -0.165, p = 0.67).

Conclusions: In the setting of severe sepsis and septic shock sublingual microcirculatory alterations were observed despite fulfillment of sepsis resuscitation guidelines. After infusion of a limited and fixed dose of MgS, microcirculatory perfusion did not improve over time.

Trial registration: ClinicalTrials.gov NTC01332734.

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Figures

Figure 1
Figure 1
Change of microvascular flow index pre- and post magnesium sulphate infusion
Figure 2
Figure 2
Linear relationship between baseline microvascular flow index and change pre- and post magnesium sulphate infusion. microvascular flow index, MFI
Figure 3
Figure 3
Linear relationship between baseline total vessel density and change pre- and post magnesium sulphate infusion. total vessel density, TVD
See this image and copyright information in PMC

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