title: Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients.
abstract: OBJECTIVE
  To assess sublingual microcirculatory changes following passive leg raising (PLR) and volume expansion (VE) in septic patients.
  
  
  METHODS
  This prospective study was conducted in two university hospital intensive care units and included 25 mechanically ventilated patients with severe sepsis or septic shock who were eligible for VE in the first 24 h of their admission. Pulse pressure variation (ΔPP), cardiac output (CO) and sublingual microcirculation indices were assessed at five consecutive steps: (1) semi-recumbent position (Baseline 1), (2) during PLR manoeuvre (PLR), (3) after returning to semi-recumbent position (Baseline 2), (4) at the time when VE induced the same degree of preload responsiveness as PLR (VE(∆PP = PLR)) and (5) at the end of VE (VE(END)). At each step, five sublingual microcirculation sequences were acquired using sidestream darkfield imaging to assess functional capillary density (FCD), microcirculatory flow index (MFI), proportion of perfused vessels (PPV) and flow heterogeneity index (FHI).
  
  
  RESULTS
  The PLR, VE(∆PP = PLR) and VE(END) induced a significant increase in CO and a significant decrease in ΔPP compared to Baseline 1 and Baseline 2 values. Both PLR and VE induced significant increases in FCD, MFI and PPV and a significant decrease in FHI compared to Baseline 1 and Baseline 2 values.
  
  
  CONCLUSIONS
  In preload responsive severe septic patients examined within the first 24 h of their admission, both PLR and VE improved sublingual microcirculatory perfusion. At the level of volume infusion used in this study, these changes in sublingual microcirculation were not explained by changes in rheologic factors or changes in arterial pressure.
authors: Unité EA 3509, Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris 11, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France.
authors: Julien
authors: J
authors: Pottecher
authors: Stéphane
authors: S
authors: Deruddre
authors: Jean-Louis
authors: JL
authors: Teboul
authors: Jean-François
authors: JF
authors: Georger
authors: Christian
authors: C
authors: Laplace
authors: Dan
authors: D
authors: Benhamou
authors: Eric
authors: E
authors: Vicaut
authors: Jacques
authors: J
authors: Duranteau
mesh_terms: D001810:Blood Volume / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007866:Leg / Q000502:physiology*; D008833:Microcirculation / Q000502:physiology*; D009060:Mouth Floor / Q000098:blood supply; D009068:Movement / Q000502:physiology*; D011446:Prospective Studies; D012039:Regional Blood Flow; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000503:physiopathology; D016683:Supine Position