• Journal of critical care · Oct 2013

    Changing sedative infusion from propofol to midazolam improves sublingual microcirculatory perfusion in patients with septic shock.

    • Guilherme Loures Penna, Fernanda M Fialho, Pedro Kurtz, André M Japiassú, Marcelo Kalichsztein, Gustavo Nobre, Nivaldo Ribeiro Villela, and Eliete Bouskela.
    • Laboratory for Clinical and Experimental Research on Vascular Biology-BioVasc, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; Intensive Care Unit, Casa de Saúde São José, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil. Electronic address: guipenna@terra.com.br.
    • J Crit Care. 2013 Oct 1; 28 (5): 825-31.

    PurposeThe goal of this study was to explore possible microcirculatory alterations by changing sedative infusion from propofol to midazolam in patients with septic shock.Materials And MethodsPatients (n=16) were sedated with propofol during the first 24 hours after intubation, then with midazolam, following a predefined algorithm. Systemic hemodynamics, perfusion parameters, and microcirculation were assessed at 2 time points: just before stopping propofol and 30 minutes after the start of midazolam infusion. Sublingual microcirculation was evaluated by sidestream dark-field imaging.ResultsThe microvascular flow index and the proportion of perfused small vessels were greater when patients were on midazolam than when on propofol infusion (2.8 [2.4-2.9] vs 2.3 [1.9-2.6] and 96.4% [93.7%-97.6%] vs 92.7% [88.3%-94.7%], respectively; P<.005), and the flow heterogeneity index was greater with propofol than with midazolam use (0.49 [0.2-0.8] vs 0.19 [0.1-0.4], P<.05). There were no significant changes in systemic hemodynamics and perfusion parameters either during propofol use or during midazolam infusions. Data are presented as median (25th-75th percentiles).ConclusionsIn this study, sublingual microcirculatory perfusion improved when the infusion was changed from propofol to midazolam in patients with septic shock. This observation could not be explained by changes in systemic hemodynamics.Copyright © 2013 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…