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Microvascular function and rheologic changes in hyperdynamic sepsis

M E Astiz1, G E DeGent, R Y Lin

  • 1Department of Medicine, St. Vincent's Hospital and Medical Center of New York, NY 10011.

Critical Care Medicine
|February 1, 1995
PubMed
Summary
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Severe sepsis impairs microvascular blood flow, evidenced by reduced reactive hyperemia. Rheologic changes like decreased red blood cell deformability and increased leukocyte aggregation contribute to circulatory abnormalities in sepsis.

Area of Science:

  • Critical care medicine
  • Hemodynamics
  • Microcirculation

Background:

  • Severe sepsis is characterized by complex circulatory abnormalities affecting microvascular function.
  • Understanding rheologic changes is crucial for managing sepsis-induced organ dysfunction.

Purpose of the Study:

  • To investigate rheologic changes and circulatory abnormalities at the microvascular level in patients with severe sepsis.
  • To assess the impact of sepsis on red blood cell deformability, leukocyte aggregation, and endothelial adherence.

Main Methods:

  • A prospective, controlled trial was conducted in intensive care units.
  • Forearm blood flow, reactive hyperemia, and hemodynamic parameters were measured.
  • Rheologic measurements included red blood cell deformability, leukergy (leukocyte aggregation), and CD11b/CD18 expression.

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Main Results:

  • Septic patients exhibited significantly diminished forearm reactive hyperemia compared to controls (ratio of 1.6 vs. 3.2).
  • Red blood cell deformability was significantly reduced in sepsis (0.41 vs. 0.98).
  • Increased leukocyte aggregation (leukergy) and neutrophil adhesion molecule CD11b/CD18 expression were observed in septic patients.

Conclusions:

  • Severe sepsis significantly impairs microvascular blood flow, indicated by reduced reactive hyperemia.
  • Impaired red blood cell deformability, increased leukocyte aggregation, and endothelial adherence contribute to circulatory dysfunction in sepsis.
  • These rheologic alterations may compromise capillary cross-sectional area, exacerbating microcirculatory abnormalities.