• Michel Egide van Genderen, Eva Klijn, Alexandre Lima, Jeroen de Jonge, Steven Sleeswijk Visser, Jacqueline Voorbeijtel, Jan Bakker, and Jasper van Bommel.
• 1Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. 2Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 3Department of Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands. 4Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
• Crit. Care Med.. 2014 Feb 1;42(2):e96-e105.

ObjectivesTo study regional perfusion during experimental endotoxemic and obstructive shock and compare the effect of initial cardiac output-targeted fluid resuscitation with optimal cardiac output-targeted resuscitation on different peripheral tissues.DesignControlled experimental study.SettingUniversity-affiliated research laboratory.SubjectsFourteen fasted anesthetized mechanically ventilated domestic pigs.InterventionsDomestic pigs were randomly assigned to the endotoxemic (n = 7) or obstructive shock (n = 7) model. Central and regional perfusion parameters were obtained at baseline, during greater than or equal to 50% reduction of cardiac output (T1), after initial resuscitation to baseline (T2), and after optimization of cardiac output (T3).Measurements And Main ResultsRegional perfusion was assessed in the sublingual, intestinal, and muscle vascular beds at the different time points and included visualization of the microcirculation, measurement of tissue oxygenation, and indirect assessments of peripheral skin perfusion. Hypodynamic shock (T1) simultaneously decreased all regional perfusion variables in both models. In the obstructive model, these variables returned to baseline levels at T2 and remained in this range after T3, similar to cardiac output. In the endotoxemic model, however, the different regional perfusion variables were only normalized at T3 associated with the hyperdynamic state at this point. The magnitude of changes over time between the different vascular beds was similar in both models, but the endotoxemic model displayed greater heterogeneity between tissues.ConclusionsThis study demonstrates that the relationship between the systemic and regional perfusion is dependent on the underlying cause of circulatory shock. Further research will have to demonstrate whether different microvascular perfusion variables can be used as additional resuscitation endpoints.

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