Early microvascular changes in sepsis and severe sepsis
Angeliki Spanos1, Shaman Jhanji, Amanda Vivian-Smith
1Barts & The London School of Medicine and Dentistry, Queen Mary's University of London, London, United Kingdom.
Shock (Augusta, Ga.)
|October 24, 2009
Summary
Early sepsis significantly impairs microvascular blood flow, even in the initial hours. These critical microcirculatory changes are identifiable and more severe in patients with severe sepsis and those who do not survive.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Microcirculation Research
Background:
- Sepsis survival hinges on early intervention, yet microvascular changes in early sepsis remain under-described.
- Established sepsis involves microvascular flow derangements, but data on early stages are limited.
- Understanding early microvascular dysfunction is crucial for timely sepsis management.
Purpose of the Study:
- To characterize microvascular flow changes in the early stages of sepsis (within 6 hours of presentation).
- To compare microcirculatory parameters between healthy volunteers, sepsis patients, and severe sepsis patients.
- To identify microvascular predictors of mortality in sepsis.
Main Methods:
- Observational study using sidestream dark-field imaging of sublingual microcirculation.
- Inclusion of healthy volunteers and patients presenting with sepsis or severe sepsis within 6 hours.
- Measurement of cardiac index via noninvasive suprasternal Doppler.
Main Results:
- Patients with sepsis and severe sepsis showed reduced microvascular flow index, heterogeneity index, and proportion of perfused vessels compared to healthy volunteers.
- Severe sepsis patients exhibited lower perfused vessel density than sepsis patients.
- Nonsurvivors had a lower proportion of perfused vessels and mean arterial pressure (MAP) than survivors.
Conclusions:
- Sepsis induces identifiable microvascular flow derangements early in the disease course.
- These microcirculatory abnormalities are more pronounced in severe sepsis and correlate with poorer outcomes.
- Further research is needed to fully elucidate sepsis's impact on microvascular function.
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