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  • Poster presentation
  • Open Access

Sublingual microcirculatory response to fluid challenge in septic shock patients

  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P65

https://doi.org/10.1186/cc2532

  • Published:

Keywords

  • Cardiac Output
  • Norepinephrine
  • Septic Shock
  • Spectral Imaging
  • Blood Velocity

During microcirculatory failure in septic shock, the relationship between modifications in macro-circulation and micro-circulation may depend on the resuscitation. How is the microcirculation modified during cardiac output (CO) increase by fluid?

Four septic shock patients (73 ± 12 years old) were investigated with orthogonal polarization spectral imaging (OPS) and with a Swan–Ganz catheter. The SAPS score was 60 ± 8, and norepinephrine was 0.6 ± 0.3 μg/kg/min. In three sublingual areas per patient, the number of vessels (small, medium, large) were quoted as no flow = 0, sludge = 1, moderate = 2, normal = 3, allowing one to compute a microcirculatory ratio for each vessel category. Systemic hemodynamic and OPS data were taken before and within 30 min after fluid bolus (5–7 ml/kg). OPS data presented as median (interquartile range), demographic and hemodynamic data presented as median ± SE.

Only the number of small vessels/field tended to increase after fluid from 34 (15) to 55 (21) (P = 0.09). In Fig. 1, all vessel categories increased the ratio (P < 0.01). The blood pressure did not increase after fluid challenge, whereas the CO increased by 39 ± 18% (P < 0.05; Fig. 2).

Figure 1

Figure 2
Figure 2

SAP, systolic arterial pressure; DAP, diastolic arterial pressure; CVP, central venous pressure.

All sizes of microvessels changed with fluid loading, with different patterns between small and larger vessels, going from recruitment to increased blood velocity.

Authors’ Affiliations

(1)
Hopital Lariboisière, Paris, France

Copyright

© BioMed Central Ltd. 2004

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