Subcutaneous interstitial pressure measurement during early septic shock: an exploratory study

Area of Science:

• Critical Care Medicine
• Physiology
• Fluid Dynamics

Background:

• Fluid therapy is vital for septic shock but risks fluid overload.
• Capillary leakage in sepsis can lead to interstitial fluid accumulation.
• Previous models suggest reduced interstitial pressure in sepsis, but clinical data in humans is lacking.

Purpose of the Study:

• To investigate changes in subcutaneous interstitial pressure (SIP) in human sepsis.
• To determine if SIP is lower in patients with septic shock compared to controls.

Main Methods:

• Prospective observational study in an Intensive Care Unit (ICU).
• Inclusion of adult patients under sedation and mechanical ventilation with limited fluid resuscitation.
• Measurement of SIP using a subcutaneous transducer-tip probe in septic shock and control groups.

Main Results:

• No significant difference in mean SIP between septic shock (1.69 ± 2.99 mmHg) and control groups (2.51 ± 2.39 mmHg).
• Sub-atmospheric SIP was observed in 33% of septic shock patients versus 7% of controls, though not statistically significant.
• Higher fluid balance was noted in septic shock patients despite similar SIP levels.

Conclusions:

• Subcutaneous interstitial pressure is not significantly lower in human septic shock.
• Sub-atmospheric SIP may be more prevalent in septic shock, indicating potential implications for fluid dynamics.
• Further research is needed to elucidate the role of interstitial pressure in sepsis-induced capillary leakage and fluid overload.