title: Similar Microcirculatory Alterations in Patients with Normodynamic and Hyperdynamic Septic Shock.
abstract: BACKGROUND
  In normodynamic septic shock, the quantitative assessment of sublingual microcirculation has shown decreases in perfused vascular density and red blood cell velocity. However, no studies have been performed in hyperdynamic septic shock.
  
  
  OBJECTIVE
  To characterize the microcirculatory patterns and rule out the presence of fast red blood cell velocity in patients with hyperdynamic septic shock.
  
  
  METHODS
  We prospectively evaluated the sublingual microcirculation in healthy volunteers (n = 20) and in patients with hyperdynamic (n = 20) and normodynamic (n = 20) septic shock. Hyperdynamic septic shock was defined by a cardiac index >4.0 L/min/m(2). The microcirculation was assessed with sidestream dark field imaging and AVA 3.0 software.
  
  
  RESULTS
  There were no differences in perfused vascular density, proportion of perfused vessels, or microvascular flow index between patients with hyperdynamic and normodynamic septic shock, but these variables were reduced compared with those of healthy volunteers, A similar pattern was observed in red blood cell velocity (912 ± 291, 968 ± 204, and 1303 ± 120 μm/s, respectively; P < 0.0001) and its coefficient of variation. In both types of septic shock, no microvessel had a red blood cell velocity higher than the 100th percentile value for healthy volunteers.
  
  
  CONCLUSIONS
  Patients with hyperdynamic septic shock showed microcirculatory alterations similar to those of patients with normal cardiac output. Both groups of patients had reduced perfused vascular density and red blood cell velocity and increased flow heterogeneity compared with that of healthy subjects. Fast red blood cell velocity was not found, even in patients with high cardiac output. These results support the conclusion that microcirculatory function is frequently dissociated from systemic hemodynamic derangements in septic shock.
authors.affiliation: 1 Hospital Fernández, and.|2 Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.
authors.forename: Vanina S Kanoore
authors.initials: VS
authors.lastname: Edul
authors.affiliation: 2 Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Alejandro Risso
authors.initials: AR
authors.lastname: Vazquez
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Paolo N
authors.initials: PN
authors.lastname: Rubatto
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Emilio D Valenzuela
authors.initials: ED
authors.lastname: Espinoza
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Sebastián
authors.initials: S
authors.lastname: Welsh
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Carolina
authors.initials: C
authors.lastname: Enrico
authors.affiliation: 3 Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.|4 Facultad de Ciencias Médicas, Cátedra de Farmacología Aplicada, Universidad Nacional de La Plata, La Plata, Argentina.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Dubin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D000069416:Intravital Microscopy; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D018715:Microscopy, Video; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D012772:Shock, Septic / Q000503:physiopathology*
keywords: microvessels; resuscitation; sepsis