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Observational Study
. 2019 Aug:52:213-218.
doi: 10.1016/j.jcrc.2019.05.002. Epub 2019 May 6.

Influence of systemic hemodynamics on microcirculation during sepsis

Magalie Collet  1 , Benjamin Huot  2 , Romain Barthélémy  2 , Charles Damoisel  2 , Didier Payen  3 , Alexandre Mebazaa  4 , Benjamin G Chousterman  5
Affiliations
Observational Study

Influence of systemic hemodynamics on microcirculation during sepsis

Magalie Collet et al. J Crit Care. 2019 Aug.

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).

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