title: Sublingual microcirculatory changes during high-volume hemofiltration in hyperdynamic septic shock patients.
abstract: BACKGROUND
  Previous 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Microcirculatory 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago 114-D, Chile. crbchile@yahoo.com
authors.forename: Carolina
authors.initials: C
authors.lastname: Ruiz
authors.forename: Glenn
authors.initials: G
authors.lastname: Hernandez
authors.forename: Cristian
authors.initials: C
authors.lastname: Godoy
authors.forename: Patricio
authors.initials: P
authors.lastname: Downey
authors.forename: Max
authors.initials: M
authors.lastname: Andresen
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bruhn
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*; D014059:Tongue / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology