Sublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patients

Area of Science:

• Critical Care Medicine
• Nephrology
• Hemodynamics

Background:

• High volume hemofiltration (HVHF) may reverse hypotension in severe hyperdynamic septic shock.
• Increased systemic vascular resistance from HVHF could impair microcirculation.
• The study aimed to assess HVHF's impact on sublingual microcirculation in these patients.

Purpose of the Study:

• To determine if high volume hemofiltration (HVHF) deteriorates sublingual microcirculation.
• To evaluate the effect of HVHF on microcirculatory flow index and perfused microvessels.
• To assess changes in microvascular density and heterogeneity during and after HVHF.

Main Methods:

• Prospective, non-randomized study in a university hospital ICU.
• 12 severe hyperdynamic septic shock patients received 12-hour HVHF as rescue therapy.
• Sublingual microcirculation, hemodynamics, and perfusion were assessed at baseline, 12 hours, and 6 hours post-HVHF.

Main Results:

• Microcirculatory flow index and proportion of perfused microvessels increased post-HVHF.
• Increased microcirculatory blood flow was inversely correlated with baseline levels.
• Mean arterial pressure and systemic vascular resistance rose; lactate levels decreased.

Conclusions:

• High volume hemofiltration (HVHF) did not deteriorate sublingual microcirculatory blood flow in severe hyperdynamic septic shock.
• HVHF improved microcirculatory flow and perfusion despite increased systemic vascular resistance.
• HVHF is a viable rescue therapy for severe hyperdynamic septic shock without compromising microcirculation.