Effects of fluids on microvascular perfusion in patients with severe sepsis.
OBJECTIVE
To evaluate the effects of fluid administration on microcirculatory alterations in sepsis.


METHODS
With a Sidestream Dark Field device, we evaluated the effects of fluids on the sublingual microcirculation in 60 patients with severe sepsis. These patients were investigated either within 24 h (early, n = 37) or more than 48 h (late, n = 23) after a diagnosis of severe sepsis. Hemodynamic and microcirculatory measurements were obtained before and 30 min after administration of 1,000 ml Ringer's lactate (n = 29) or 400 ml 4% albumin (n = 31) solutions.


RESULTS
Fluid administration increased perfused small vessel density from 3.5 (2.9-4.3) to 4.4 (3.7-4.9) n/mm (p < 0.01), through a combined increase in the proportion of perfused small vessels from 69 (62-76) to 79 (71-83) %, p < 0.01) and in small vessel density from 5.3 (4.4-5.9) to 5.6 (4.8-6.3) n/mm (p < 0.01). Importantly, microvascular perfusion increased in the early but not in the late phase of sepsis: the proportion of perfused small vessels increased from 65 (60-72) to 80 (75-84) % (p < 0.01) in the early phase and from 75 (66-80) to 74 (67-81) (p = ns) in the late phase. These microvascular effects of fluids were not related to changes in cardiac index (R(2) = 0.05, p = ns) or mean arterial pressure (R(2) = 0.04, p = ns).


CONCLUSIONS
In this non-randomized trial, fluid administration improved microvascular perfusion in the early but not late phase of sepsis. This effect is independent of global hemodynamic effects and of the type of solution.
Ospina-Tascon
Gustavo
G
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Neves
Ana Paula
AP
Occhipinti
Giovanna
G
Donadello
Katia
K
Büchele
Gustavo
G
Simion
Davide
D
Chierego
Maria-Luisa
ML
Silva
Tatiana Oliveira
TO
Fonseca
Adriana
A
Vincent
Jean-Louis
JL
De Backer
Daniel
D
D000368:Aged; D000418:Albumins / Q000008:administration & dosage / Q000378:metabolism; D002302:Cardiac Output; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000378:metabolism; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D010477:Perfusion; D000077325:Ringer's Lactate; D018805:Sepsis / Q000503:physiopathology*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000418:Albumins; D007552:Isotonic Solutions; D000077325:Ringer's Lactate