title: Papaverine improves sublingual blood flow in patients with septic shock.
abstract: BACKGROUND
  In recent years, microcirculatory blood flow alterations have been recognized to be stronger predictors of septic shock treatment outcomes than global hemodynamic variables.
  
  
  METHODS
  In our self-controlled, interventional pilot clinical trial study, we investigated the effects of a single papaverine injection on the microcirculation in sepsis patients undergoing fluid resuscitation combined with vasopressor treatments. Fourteen septic shock patients admitted to the Peking University Third Hospital were included in the study, and each patient received 30 mg papaverine, which is the approximate dosage used to treat a conventional arterial spasm. Papaverine was administered as an intravenous bolus injection after systemic hemodynamic stabilization had been achieved by means of fluid resuscitation combined with dopamine and/or norepinephrine vasopressor medication. Baseline characteristics, as well as global hemodynamic and blood gas parameters, before and 60 min after papaverine injection were recorded and sublingual microcirculatory data at baseline and 15, 30, and 60 min after papaverine administration obtained using sidestream dark-field video microscopy.
  
  
  RESULTS
  The perfused vessel density of small vessels was significantly increased 30 and 60 min after papaverine administration (P < 0.01), and the proportion of perfused small vessels (PPV), as well as the microvascular flow index, was significantly increased 30 min after papaverine (P < 0.05). There were no visible systemic effects, arrhythmia, or hypotension during the observation period in each patient.
  
  
  CONCLUSIONS
  In our pilot study, papaverine transiently improved sublingual microcirculatory blood flow without influencing systemic hemodynamics in patients with septic shock, who required vasoconstrictors to maintain blood pressure during fluid resuscitation.
authors: Department of Intensive Care, Peking University Third Hospital, Beijing, China.
authors: Hongliang
authors: H
authors: Li
authors: Department of Intensive Care, Peking University Third Hospital, Beijing, China.
authors: Xi
authors: X
authors: Zhu
authors: Department of Intensive Care, Peking University Third Hospital, Beijing, China.
authors: Gaiqi
authors: G
authors: Yao
authors: Department of Intensive Care, Peking University Third Hospital, Beijing, China. Electronic address: bysyiculihongliang@126.com.
authors: Zongyu
authors: Z
authors: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D009061:Mouth Mucosa / Q000098:blood supply; D010208:Papaverine / Q000494:pharmacology / Q000627:therapeutic use*; D008517:Phytotherapy; D010865:Pilot Projects; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy*; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D010936:Plant Extracts; D014665:Vasodilator Agents; D010208:Papaverine
keywords: Microcirculation; Microvascular flow index; Papaverine; Perfused vessel; Septic shock; Sidestream dark-field imaging