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Nitroglicerina en el shock séptico después de la resucitación del volumen intravascular
Peter E Spronk1, Can Ince, Martin J Gardien
1Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
Lancet (London, England)
|November 9, 2002
Resumen
La nitroglicerina mejoró el flujo sanguíneo microcirculador en pacientes con shock séptico. Esto sugiere que mejorar la microcirculación podría ser un nuevo objetivo de reanimación para el shock séptico.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- Fisiología Fisiología Fisiología.
- Imágenes médicas de imágenes médicas.
Sus antecedentes:
- El shock séptico implica un mayor consumo de oxígeno y un deterioro de la entrega / extracción debido a la disfunción microcirculatoria.
- El cierre y la derivación de la microcirculación contribuyen al deterioro de la oxigenación en el shock séptico.
- La imagen espectral de polarización ortogonal (OPS) ofrece una visualización directa de la microcirculación.
Objetivo del estudio:
- Evaluar el impacto de la nitroglicerina en el flujo microcircular en pacientes con shock séptico.
- Evaluar el potencial del reclutamiento de microcirculación como punto final de reanimación.
Principales métodos:
- Utilizó imágenes espectral de polarización ortogonal (OPS) para visualizar la microcirculación.
- Pacientes monitoreados con shock séptico y parámetros hemodinámicos específicos (MAP> 60 mm Hg, CVP> 12 mm Hg).
- Se administró nitroglicerina intravenosa (0,5 mg) y se observaron cambios en el flujo microvascular.
Principales resultados:
- La infusión de nitroglicerina condujo a un aumento significativo en el flujo microvascular observado a través de imágenes de OPS.
- Se ha demostrado una mejora de la perfusión microcirculatoria después de la administración de nitroglicerina.
- Se observó una mayor contratación de la microcirculación.
Conclusiones:
- La nitroglicerina mejora efectivamente el flujo sanguíneo microcirculador en el shock séptico.
- El reclutamiento microcircular puede servir como un punto final de reanimación novedoso y valioso en el manejo del shock séptico.
- La imagen de OPS es una herramienta viable para evaluar las respuestas microcirculadoras a las intervenciones en enfermedades críticas.
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