Abstract
IntroductionPrevious studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients. However, arterial pressure stabilization occurs due to an increase in systemic vascular resistance, which could eventually compromise microcirculatory blood flow and perfusion. The goal of this study was to determine if HVHF deteriorates sublingual microcirculation in severe hyperdynamic septic shock patients.MethodsThis was a prospective, non-randomized study at a 16-bed, medical-surgical intensive care unit of a university hospital. We included 12 severe hyperdynamic septic shock patients (norepinephrine requirements > 0.3 μg/kg/min and cardiac index > 3.0 L/min/m2) who underwent a 12-hour HVHF as a rescue therapy according to a predefined algorithm. Sublingual microcirculation (Microscan for NTSC, Microvision Medical), systemic hemodynamics and perfusion parameters were assessed at baseline, at 12 hours of HVHF, and 6 hours after stopping HVHF.ResultsMicrocirculatory flow index increased after 12 hours of HVHF and this increase persisted 6 hours after stopping HVHF. A similar trend was observed for the proportion of perfused microvessels. The increase in microcirculatory blood flow was inversely correlated with baseline levels. There was no significant change in microvascular density or heterogeneity during or after HVHF. Mean arterial pressure and systemic vascular resistance increased while lactate levels decreased after the 12-hour HVHF.ConclusionsThe use of HVHF as a rescue therapy in patients with severe hyperdynamic septic shock does not deteriorate sublingual microcirculatory blood flow despite the increase in systemic vascular resistance.
Highlights
Previous studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients
Septic patients presenting a circulatory dysfunction at the emergency department or the pre-intensive care unit are subjected to vigorous fluid resuscitation followed by central venous catheter insertion and basal measurements of lactate (Radiometer ABL 735; Radiometer, Brønshøj, Denmark) and central venous oxygen saturation (ScvO2)
The use of HVHF as a rescue therapy in patients with severe hyperdynamic septic shock is not associated with deterioration of sublingual microcirculation, despite the increase in systemic vascular resistance
Summary
Previous studies have suggested that high volume hemofiltration (HVHF) may contribute to revert hypotension in severe hyperdynamic septic shock patients. High-volume hemofiltration (HVHF) is a potential rescue therapy in patients with severe septic shock, and some clinical studies suggest that HVHF can decrease vasopressor requirements and improve lactate clearance [1,2]. Microcirculation is known to be markedly compromised during septic shock and these disturbances are considered to play a central role in multiple organ failure. By means of these novel techniques, the impact of conventional therapies on microcirculation is starting to be unraveled [6,7,8,9]
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