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Báo cáo y học: "Sublingual microcirculatory changes during highvolume hemofiltration in hyperdynamic septic shock patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Sublingual microcirculatory changes during highvolume hemofiltration in hyperdynamic septic shock patients. | Ruiz et al. Critical Care 2010 14 R170 http ccforum.eom content 14 5 R170 c CRITICAL CARE RESEARCH Open Access Sublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patients 1 1 Z 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 pg 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 after HVHF. Mean arterial pressure and systemic vascular resistance increased while lactate levels decreased after the 12-hour HVHF. Conclusions The use of HVHF as a rescue therapy in patients with severe hyperdynamic septic shock does not deteriorate sublingual microcirculatory .