• Glenn Hernandez, E Christiaan Boerma, Arnaldo Dubin, Alejandro Bruhn, Matty Koopmans, Vanina Kanoore Edul, Carolina Ruiz, Ricardo Castro, Mario Omar Pozo, Cesar Pedreros, Enrique Veas, Andrea Fuentealba, Eduardo Kattan, Maximiliano Rovegno, and Can Ince.
• Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. glennguru@gmail.com
• J Crit Care. 2013 Aug 1;28(4):538.e9-14.

PurposeThe aims of this study are to determine the general relationship of perfused vessel density (PVD) to mortality and organ dysfunctions and to explore if patients in the lowest quartile of distribution for this parameter present a higher risk of bad outcome and to identify systemic hemodynamic and perfusion variables that enhances the probability of finding a severe underlying microvascular dysfunction.Materials And MethodsThis is a retrospective multicenter study including 122 septic shock patients participating in 7 prospective clinical trials on which at least 1 sublingual microcirculatory assessment was performed during early resuscitation.ResultsPerfused vessel density was significantly related to organ dysfunctions and mortality, but this effect was largely explained by patients in the lowest quartile of distribution for PVD (P = .037 [odds ratio {OR}, 8.7; 95% confidence interval {CI}, 1.14-66.78] for mortality). Hyperlactatemia (P < .026 [OR, 1.23; 95% CI, 1.03-1.47]) and high norepinephrine requirements (P < .019 [OR, 7.04; 95% CI, 1.38-35.89]) increased the odds of finding a severe microvascular dysfunction.ConclusionsPerfused vessel density is significantly related to organ dysfunctions and mortality in septic shock patients, particularly in patients exhibiting more severe abnormalities as represented by the lowest quartile of distribution for this parameter. The presence of hyperlactatemia and high norepinephrine requirements increases the odds of finding a severe underlying microvascular dysfunction during a sublingual microcirculatory assessment.Copyright © 2013 Elsevier Inc. All rights reserved.

40 keywords...

hide…