Similar Microcirculatory Alterations in Patients with Normodynamic and Hyperdynamic Septic Shock
Vanina S Kanoore Edul1,2, Can Ince2, Alejandro Risso Vazquez3
11 Hospital Fernández, and.
Annals of the American Thoracic Society
|December 2, 2015
Summary
Microcirculatory alterations in septic shock, including reduced red blood cell velocity, are similar in hyperdynamic and normodynamic states. Fast red blood cell velocity was not observed, even with high cardiac output in hyperdynamic septic shock.
Area of Science:
- Critical care medicine
- Hemodynamics
- Microcirculation research
Background:
- Septic shock is characterized by hemodynamic alterations.
- Normodynamic septic shock shows reduced microcirculatory perfusion and red blood cell velocity.
- Microcirculation in hyperdynamic septic shock remains understudied.
Purpose of the Study:
- To characterize sublingual microcirculatory patterns in hyperdynamic septic shock.
- To investigate the presence of fast red blood cell velocity in hyperdynamic septic shock.
- To compare microcirculation between hyperdynamic and normodynamic septic shock patients and healthy volunteers.
Main Methods:
- Prospective evaluation of sublingual microcirculation using sidestream dark field imaging and AVA 3.0 software.
- Study included healthy volunteers (n=20), hyperdynamic septic shock patients (n=20, cardiac index >4.0 L/min/m²), and normodynamic septic shock patients (n=20).
- Quantitative assessment of perfused vascular density, proportion of perfused vessels, microvascular flow index, and red blood cell velocity.
Main Results:
- Perfused vascular density, proportion of perfused vessels, and microvascular flow index were reduced in both hyperdynamic and normodynamic septic shock groups compared to healthy volunteers.
- Red blood cell velocity was significantly lower in both septic shock groups compared to healthy volunteers (P < 0.0001).
- No significant differences in microcirculatory parameters were found between hyperdynamic and normodynamic septic shock patients; fast red blood cell velocity was absent in all septic shock patients.
Conclusions:
- Hyperdynamic septic shock exhibits microcirculatory alterations comparable to normodynamic septic shock.
- Both septic shock states display reduced microvascular density and red blood cell velocity, alongside increased flow heterogeneity, compared to healthy individuals.
- Microcirculatory dysfunction in septic shock appears independent of systemic hemodynamic status, particularly high cardiac output.
