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Open Access

Acetylcholine can totally reverse alterations in microvascular blood flow that occur in patients with septic shock

  • D De Backer1,
  • J Creteur1,
  • M-J Dubois1,
  • J-C Preiser1 and
  • J-L Vincent1
Critical Care20015(Suppl 3):P25

Published: 26 June 2001


Public HealthBlood FlowHealthy VolunteerSeptic ShockAcetylcholine


We recently observed, using an orthogonal polarization spectral (OPS) imaging device, that microvascular blood flow is altered in patients with sepsis. We hypothesized that these alterations may be reversed by acetylcholine (ACH).


We used an OPS device (Cytoscan A/RII; Cytometrics, Philadelphia, USA) with a 5× magnitude to explore the sublingual area in 11 patients with septic shock and 10 healthy volunteers. In each case, five sublingual areas were recorded for later analysis. Septic patients also received topical application of ACH 10-2 M. Five representative sequences of 20 s were analyzed semiquantitatively: vessel density was defined as the number of vessels crossing three horizontal and three vertical lines; flow was defined as continuous, intermittent, and absent. The vessels were then separated into venules and capillaries using a 20 μm cutoff value. Data from the five areas were averaged and analyzed by Kruskall-Wallis and Wilcoxon tests. Data are presented as median (percentiles 25-75).


See Table.



Patients with septic shock



ACH 10-2

Healthy volunteers

Total, n/mm

4.9 (4.1-5.7)

6.0 (4.7-6.4)*

5.4 (5.4-6.3)*

Proportion of vessels perfused, %

83 (77-96)

99 (98-100)*

98 (97-99)*

Proportion of venules perfused, %

100 (100-100)

100 (100-100)


Proportion of capillaries perfused, %

44 (24-60)

94 (77-96)*

94 (92-95)*

Absent flow (capillaries), %

29 (8-44)

1 (0-3)*

3 (2-5)*

Intermittent flow (capillaries), %

24 (19-38)

8 (3-19)*

5 (3-6)*

*P < 0.01 versus base.


Microcirculatory alterations in patients with septic shock can be reversed by topical ACH, suggesting that these alterations are primarily due to an increased vasomotor tone.

Authors’ Affiliations

Department of Intensive Care, Erasme University Hospital, Brussels, Belgium


© The Author(s) 2001