Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: Relationship to hemodynamics, oxygen transport, and survival
Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: Relationship to hemodynamics, oxygen transport, and survival
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DOI：
10.1016/j.annemergmed.2006.08.021
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发表时间：
2007-01-01
影响因子：
6.2
通讯作者：
Hollenberg, Steven M.
中科院分区：
文献类型：
--
作者：
Trzeciak, Stephen;Dellinger, R. Phillip;Hollenberg, Steven M.
研究目的：研究严重脓毒症/脓毒性休克患者的早期微循环灌注指数，比较脓毒症幸存者与非幸存者的早期微循环指数，并确定与早期微循环灌注指数相关的全身血流动力学/氧转运变量。方法：这项前瞻性观察性研究使用正交偏振光谱成像直接显示严重脓毒症患者的舌下微循环，早期目标导向治疗的败血性休克。我们在早期目标导向治疗开始后6小时内进行初始成像，并以24小时间隔进行后期随访研究，直至死亡或器官功能障碍消退。我们对5个舌下部位进行成像，并以盲法离线分析数据。我们计算了3个微循环灌注指数：血流速度评分、血流异质性指数和毛细血管密度。我们分析了早期数据，比较幸存者与非幸存者，并检查与全身血流动力学测量的相关性。我们采用线性混合效应模型进行纵向analysis.Results：我们进行了66正交偏振光谱研究26例败血症患者。与存活者相比，死亡者的早期微循环指标受损更明显（血流速度更低，灌注更不均匀）。这些相同的早期指标，流速和异质性，也更显着受损的严重程度增加的全身性心血管功能障碍（动脉压降低或增加血管加压药的需求）。结论：早期微循环灌注指标在严重脓毒症和脓毒性休克更显着受损的非幸存者相比，幸存者和全球心血管功能障碍的严重程度增加。
Study objective: To study early microcirculatory perfusion indices in patients with severe sepsis/septic shock, compare early microcirculatory indices in sepsis survivors versus nonsurvivors, and identify systemic hemodynamic/oxygen transport variables that correlate with early microcirculatory perfusion indices.Methods: This prospective observational study used orthogonal polarization spectral imaging to directly visualize the sublingual microcirculation in patients with severe sepsis/septic shock treated with early goal-directed therapy. We performed initial imaging within 6 hours of early goal-directed therapy initiation and late follow-up studies at 24-hour intervals until death or resolution of organ dysfunction. We imaged 5 sublingual sites and analyzed the data offline in a blinded fashion. We calculated 3 microcirculatory perfusion indices: flow velocity score, flow heterogeneity index, and capillary density. We analyzed early data to compare survivors versus nonsurvivors; and examine correlations with systemic hemodynamic measurements. We used a linear mixed-effects model for longitudinal analyses.Results: We performed 66 orthogonal polarization spectral studies in 26 sepsis patients. Early microcirculatory indices were more markedly impaired (lower flow velocity and more heterogeneous perfusion) in nonsurvivors compared with survivors. These same early indices, flow velocity and heterogeneity, were also more markedly impaired with increasing severity of systemic cardiovascular dysfunction (lower arterial pressure or increasing vasopressor requirement).Conclusion: Early microcirculatory perfusion indices in severe sepsis and septic shock are more markedly impaired in nonsurvivors compared with survivors and with increasing severity of global cardiovascular dysfunction.