title: Effects of fluids on microvascular perfusion in patients with severe sepsis.
abstract: 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.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ospina-Tascon
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Neves
authors.forename: Giovanna
authors.initials: G
authors.lastname: Occhipinti
authors.forename: Katia
authors.initials: K
authors.lastname: Donadello
authors.forename: Gustavo
authors.initials: G
authors.lastname: Büchele
authors.forename: Davide
authors.initials: D
authors.lastname: Simion
authors.forename: Maria-Luisa
authors.initials: ML
authors.lastname: Chierego
authors.forename: Tatiana Oliveira
authors.initials: TO
authors.lastname: Silva
authors.forename: Adriana
authors.initials: A
authors.lastname: Fonseca
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
mesh_terms: 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
chemical_list: D000418:Albumins; D007552:Isotonic Solutions; D000077325:Ringer's Lactate