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Cecal Ligation Puncture Procedure

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Published on: May 7, 2011

Effects of Fluids on the Sublingual Microcirculation in Sepsis.

Rachael Cusack^1,2, Susan O'Neill², Ignacio Martin-Loeches^1,2

¹School of Medicine, Trinity College, Pearse Street, D02 R590 Dublin, Ireland.

Journal of Clinical Medicine

|December 23, 2022

Summary

Fluid boluses did not show clear effects on sepsis microcirculation. Heterogeneity in studies suggests current classifications may not capture distinct microcirculation characteristics, necessitating further research into fluid resuscitation and sepsis phenotypes.

Keywords:

fluid resuscitation intensive care microcirculation resuscitation sepsis septic shock

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Published on: May 10, 2024

Area of Science:

Critical Care Medicine
Hemodynamics
Microcirculation Research

Background:

Sepsis is a life-threatening condition common in Intensive Care Units.
Microcirculatory changes are recognized in sepsis patients.
Fluid therapy is a primary intervention, but its impact on sepsis microcirculation is unclear.

Purpose of the Study:

To systematically review evidence on microcirculatory outcomes following fluid bolus in sepsis.
To assess the utility of handheld intravital microscopy in guiding fluid resuscitation.
To evaluate fluid bolus effects on sublingual microcirculation in sepsis and septic shock.

Main Methods:

Systematic search of Embase, CENTRAL, and Medline (PubMed).
Keywords: microcirculation, fluid, fluid resuscitation, fluid bolus, sepsis, septic shock.
Included 15 studies (6 RCTs, 9 observational) with 813 participants (2007-2021).
Predominantly used Sidestream Dark Field microscopy and Hydroxyethyl Starch.

Main Results:

No clear effects of fluid bolus on microcirculation parameters were observed.
Significant heterogeneity in study methodologies precluded meta-analysis.
Identified heterogeneity in patient responses, suggesting limitations in current clinical classifications.

Conclusions:

Current evidence does not demonstrate a clear impact of fluid bolus on sepsis microcirculation.
Microcirculation assessment could aid in defining sepsis phenotypes.
Further research is needed on various resuscitation fluids and their microcirculatory effects in sepsis.