title: Tissue perfusion and oxygenation to monitor fluid responsiveness in critically ill, septic patients after initial resuscitation: a prospective observational study.
abstract: Fluid therapy after initial resuscitation in critically ill, septic patients may lead to harmful overloading and should therefore be guided by indicators of an increase in stroke volume (SV), i.e. fluid responsiveness. Our objective was to investigate whether tissue perfusion and oxygenation are able to monitor fluid responsiveness, even after initial resuscitation. Thirty-five critically ill, septic patients underwent infusion of 250 mL of colloids, after initial fluid resuscitation. Prior to and after fluid infusion, SV, cardiac output sublingual microcirculatory perfusion (SDF: sidestream dark field imaging) and skin perfusion and oxygenation (laser Doppler flowmetry and reflectance spectroscopy) were measured. Fluid responsiveness was defined by a ≥5 or 10% increase in SV upon fluids. In responders to fluids, SDF-derived microcirculatory and skin perfusion and oxygenation increased, but only the increase in cardiac output, mean arterial and pulse pressure, microvascular flow index and relative Hb concentration and oxygen saturation were able to monitor a SV increase. Our proof of principle study demonstrates that non-invasively assessed tissue perfusion and oxygenation is not inferior to invasive hemodynamic measurements in monitoring fluid responsiveness. However skin reflectance spectroscopy may be more helpful than sublingual SDF.
authors.affiliation: Departments of Intensive Care, Erasmus MC University Medical Centre, PO box 2040, Room H 621, 3000 CA, Rotterdam, The Netherlands. evaklijn@hotmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Klijn
authors.affiliation: Departments of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Marit H N
authors.initials: MH
authors.lastname: van Velzen
authors.affiliation: Departments of Intensive Care, Erasmus MC University Medical Centre, PO box 2040, Room H 621, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Alexandre Pinto
authors.initials: AP
authors.lastname: Lima
authors.affiliation: Departments of Intensive Care, Erasmus MC University Medical Centre, PO box 2040, Room H 621, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
authors.affiliation: Departments of Intensive Care, Erasmus MC University Medical Centre, PO box 2040, Room H 621, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Jasper
authors.initials: J
authors.lastname: van Bommel
authors.affiliation: Departments of Intensive Care, Erasmus MC University Medical Centre, PO box 2040, Room H 621, 3000 CA, Rotterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D002302:Cardiac Output; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012151:Resuscitation; D018805:Sepsis / Q000503:physiopathology* / Q000628:therapy*; D012867:Skin / Q000098:blood supply; D013318:Stroke Volume; D016896:Treatment Outcome
keywords: Fluid loading; Microcirculation; Microvascular oxygenation; Passive leg raising; Septic shock