Severe Sepsis, Septic Shock, Microcirculation
Conditions
Keywords
sepsis, microcirculation, saline, crystalloid, colloid, albumin, hydroxyethyl starch
Brief summary
Major microvascular blood flow alterations have been documented in patients with severe sepsis. It was also demonstrated that the microcirculation improved in survivors of septic shock but failed to do so in patients dying from acute circulatory failure or with multiple organ failure after shock resolution. Early, effective fluid resuscitation is a key component in the management of patients with severe sepsis and septic shock with the goal of improving tissue perfusion. The best fluid in this early resuscitation phase has been and still is under debate. The aim of this study is to evaluate the effect of Three different Fluids(Albumin 5%, Normal Saline, HES 130 kD) on microcirculation in severe sepsis/septic shock patients using Sidestream Dark Field (SDF) Microscopy and Near-Infrared Spectroscopy (NIRS) analysis.
Interventions
DEVICESidestream Dark Field (SDF)
SDF will be applied to the sublingual microvascular network with a 5X objective providing a 167X magnification. After the removal of saliva and other secretions using gauze, the device will be gently applied (without any pressure) on the lateral side of the tongue, in an area approximately 1.5-4 cm from the tip of the tongue. Five sequences of 20 secs each from different adjacent areas will be recorded using a computer and a video card and stored under a random number for later analysis. This will be done at baseline and then 1 hour after Fluid bolus.
Tissue oxygen saturation (StO2) will be measured by a tissue spectrometer, a noninvasive tool, which uses reflectance mode probes to measure scattering light reflected at some distance from where the light is transmitted into the tissue. The NIRS probe will be placed on the skin of the thenar eminence and a sphygmomanometer cuff will be wrapped around the arm over the brachial artery. After a 3-min period to stabilize the NIRS signal, arterial inflow will be stopped (VOT) by inflating the cuff to 50 mmHg above the systolic arterial pressure. After 3 min of ischemia, cuff pressure will be released, and StO2 recorded continuously for another 3 min period (reperfusion period=Reactive Hyperemia).This will be done at baseline and then 1 hour after fluid bolus.
Sponsors
Mercy Research
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients will be enrolled within 24 hrs of onset of severe sepsis/septic shock with an indication for fluid bolus administration.
Exclusion criteria
* Liver cirrhosis * shock from other causes * Oral injuries (precluding SDF imaging) * Severe peripheral vascular disease, dialysis fistula, or mastectomies precluding safe forearm occlusion * Age \< 18 years
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Microcirculatory perfusion and flow variables | 1 hour after fluid bolus | obtained by Sidestream Dark Field (SDF) microscopy |
| Muscle tissue oxygenation and oxygen consumption | 1 hour after fluid bolus | using Near Infrared spectroscopy (NIRS) |
| change in microcirculatory and oxygenation variables | 1 hour after fluid bolus compared to baseline microcirculatory and oxygenation variables | obtained by both SDF and NIRS |
Countries
United States
Outcome results
None listed