title: Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock.
abstract: OBJECTIVE
  To characterize the time course of microcirculatory alterations and their relation to outcome in patients with septic shock.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Thirty-one-bed, medico-surgical intensive care unit in a university hospital.
  
  
  METHODS
  Forty-nine patients with septic shock.
  
  
  METHODS
  The sublingual microcirculation was investigated with an orthogonal polarization spectral imaging device on the day of onset of septic shock (baseline) and each day until resolution of shock.
  
  
  RESULTS
  Five sequences of 20 secs each were recorded and analyzed off-line by a semiquantitative method. Data were analyzed with nonparametric tests and presented as median (25th-75th percentiles). Three patients died after the resolution of shock from unrelated causes and were excluded. Of the other 46 patients, 26 survived and 20 died: 13 due to unresolving shock and seven due to persistent multiple organ failure after resolution of shock. At the onset of shock, survivors and nonsurvivors had similar vascular density (5.6 [4.7-7.0] vs. 6.2 [5.4-7.0]/mL; p = nonsignificant) and percentage of perfused small vessels (65.0 [53.1-68.9] vs. 58.4 [47.5-69.1]%; p = nonsignificant). Small vessel perfusion improved over time in survivors (analysis of variance, p <.05 between survivors and nonsurvivors) but not in nonsurvivors. Despite similar hemodynamic and oxygenation profiles and use of vasopressors at the end of shock, patients dying after the resolution of shock in multiple organ failure had a lower percentage of perfused small vessels than survivors (57.4 [46.6-64.9] vs. 79.3 [67.2-83.2]%; p =.02).
  
  
  CONCLUSIONS
  Microcirculatory alterations improve rapidly in septic shock survivors but not in patients dying with multiple organ failure, regardless of whether shock has resolved.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Marc-Jacques
authors.initials: MJ
authors.lastname: Dubois
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001530:Belgium / Q000453:epidemiology; D002196:Capillaries / Q000502:physiology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008833:Microcirculation; D008859:Microscopy, Polarization; D018715:Microscopy, Video; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D010100:Oxygen / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D018709:Statistics, Nonparametric
chemical_list: D010100:Oxygen