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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

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Author(s):
Rabello Filho, Roberto [1] ; de Freitas Chaves, Renato Carneiro [1, 2] ; Cesar Assuncao, Murillo Santucci [1] ; Neto, Ary Serpa [1, 3] ; De Freitas, Flavia Manfredi [1] ; Romagnoli, Maria Laura [1] ; Silva, Eliezer [1] ; Lattanzio, Bernardo [4] ; Dubin, Arnaldo [4, 5] ; Domingos Correa, Thiago [1]
Total Authors: 10
Affiliation:
[1] Hosp Israelita Albert Einstein, Dept Terapia Intens, Ave Albert Einstein, 627-701, 5th Floor, BR-05651901 Sao Paulo - Brazil
[2] Irmandade Santa Casa Misericordia Santos, Dept Anestesiol, Santos, SP - Brazil
[3] Univ Amsterdam, Dept Intens Care, Acad Med Ctr, Amsterdam - Netherlands
[4] Univ Nacl La Plata, Catedra Farmacol Aplicada, Fac Ciencias Med, La Plata, Buenos Aires - Argentina
[5] Sanatorio Otamendi, Serv Terapia Intens, Buenos Aires, DF - Argentina
Total Affiliations: 5
Document type: Journal article
Source: JOURNAL OF CLINICAL MONITORING AND COMPUTING; NOV 2019.
Web of Science Citations: 0
Abstract

Microvascular dysfunction has been associated with adverse outcomes in critically ill patients, and the current concept of hemodynamic incoherence has gained attention. Our objective was to perform a comprehensive analysis of microcirculatory perfusion parameters and to investigate the best variables that could discriminate patients with and without circulatory shock during early intensive care unit (ICU) admission. This prospective observational study comprised a sample of 40 adult patients with and without circulatory shock (n = 20, each) admitted to the ICU within 24 h. Peripheral clinical {[}capillary refill time (CRT), peripheral perfusion index (PPI), skin-temperature gradient (Tskin-diff)] and laboratory {[}arterial lactate and base excess (BE)] perfusion parameters, in addition to near-infrared spectroscopy (NIRS)-derived variables were simultaneously assessed. While lactate, BE, CRT, PPI and Tskin-diff did not differ significantly between the groups, shock patients had lower baseline tissue oxygen saturation (StO(2)) {[}81 (76-83) % vs. 86 (76-90) %, p = 0.044], lower StO(2)min {[}50 (47-57) % vs. 55 (53-65) %, p = 0.038] and lower StO(2)max {[}87 (80-92) % vs. 93 (90-95) %, p = 0.017] than patients without shock. Additionally, dynamic NIRS variables {[}recovery time (r = 0.56, p = 0.010), descending slope (r = - 0.44, p = 0.05) and ascending slope (r = - 0.54, p = 0.014)] and not static variable {[}baseline StO(2) (r = - 0.24, p = 0.28)] exhibited a significant correlation with the administered dose of norepinephrine. In our study with critically ill patients assessed within the first twenty-four hours of ICU admission, among the perfusion parameters, only NIRS-derived parameters could discriminate patients with and without shock. (AU)

FAPESP's process: 14/11120-0 - Vasodilatory therapy with nitroglyceryn in patients with septic shock
Grantee:Eliezer Silva
Support type: Regular Research Grants