title: Persistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care.
abstract: OBJECTIVE
  To investigate the time course and predictive value of microvascular alterations in children with severe sepsis.
  
  
  METHODS
  Single-center, prospective observational study.
  
  
  METHODS
  Intensive care unit of a level III university children's hospital.
  
  
  METHODS
  Patients with septic shock, requiring the administration of fluid and vasopressor agents and/or inotropes after the correction of hypovolemia, who were intubated and ventilated, were included.
  
  
  METHODS
  None.
  
  
  RESULTS
  The microcirculation was assessed in the buccal mucosa, using orthogonal polarization spectral imaging, within 24 hrs after admission. Subsequent measurements were performed every 24 hrs for 3 days. The measurements were discontinued when the patient was extubated. There were no significant differences in the functional capillary density or microvascular flow index for all vessel types between survivors and nonsurvivors on day 1. In the survival group, the functional capillary density increased significantly between day 1 and day 2 from 1.7 cm/cm (0.8-3.4) to 4.3 cm/cm (2.1-6.9) (p = .001). Functional capillary density values in nonsurvivors did not change (day 1: 3.2 cm/cm [0.8-3.8]; day 2: 1.9 cm/cm [1.0-2.1]). The median functional capillary density on days 2 and 3 were significantly lower in nonsurvivors (day 2: 1.9 cm/cm [1.0 -2.1] vs. 4.3 cm/cm [2.1-6.9], p = .009; day 3: 1.8 cm/cm [1.0-2.0] vs. 4.7 cm/cm [2.1-8.6], p = .01). The microvascular flow index for all vessel types improved in survivors and did not change in nonsurvivors. Differences in microvascular flow index values between survivors and nonsurvivors were not significant.
  
  
  CONCLUSIONS
  Persistent microcirculatory alterations can be prognostic for survival in children with septic shock.
authors.affiliation: Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Anke P C
authors.initials: AP
authors.lastname: Top
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Neelke
authors.initials: N
authors.lastname: de Meij
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D002196:Capillaries / Q000502:physiology; D002423:Cause of Death; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D009061:Mouth Mucosa / Q000098:blood supply*; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012772:Shock, Septic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014654:Vascular Patency / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology