Non specified septicemias
Conditions
Interventions
This study was divided into two sub-studies that occurred simultaneously from July 12, 2010 to December 16, 2011 at Unidade de Pacientes Graves (UPG), Instituto Fernandes Figueira (IFF), Fundação Oswa
E01.370.350.515.624
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Sponsors
Instituto Fernandes Figueira
Universidade do Estado do Rio de Janeiro
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Eligibility
Age
1 Months to 18 Years
Inclusion criteria
Inclusion criteria: Children admitted to the unidadae de pacientes graves (UPG) of Instituto Fernandes Figueira (IFF) Fiocruz; ages between one month and 18 years; diagnosis of severe sepsis or septic shock; indication of mechanical ventilation; in the case of control patients children hospitalized for elective minor surgery.
Exclusion criteria
Exclusion criteria: Children with body mass below 3kg;contraindications to dark field sidestream device (SDF) assessment as severe bleeding in the sublingual mucosa or malformation of the face that prevented the opening of the mouth;contraindications to indirect calorimetry monitoring or factors that decrease the accuracy of the method such as need for mechanical ventilation with inspired oxygen fraction (FiO2) greater than 85%, need for mechanical ventilation with expiratory pressure at the end of expiration (PEEP) greater than 12 cm H2O; escape around the orotracheal tube expressed by the difference between the inspired tidal volume and the expired tidal volume greater than 10%; presence of bronchopleural fistula; need to use other gases in the mixture such as nitric oxide and heliox; use of respirators with continuous flow; continuous hemodialysis and patients with pulmonary disease with chronic hypercapnia; presence of congenital heart disease; shock from other etiologies; liver cirrhosis, cancer; type I diabetes mellitus and autoimmune rheumatological diseases; conditions that cause microvascular derangements which may confound data analysis; indeterminate or unknown diagnosis time of septic shock; children whose parents or legal guardians did not agree or refused to sign the written informed consent.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The density of small perfused vessels (DVPP) was low in all patients in the five data collection times (time of diagnosis of septic shock diagnosis, 24 hours, 48 ??hours and 72 hours after diagnosis and immediately before extubation), when compared to those obtained in studies with septic adult patients, who used the same microcirculation analysis guideline; the proportion of small perfused vessels (PVPP) was considered abnormal (less than 90%, according to criteria established by specialists) in eleven patients in the first and second measurements, in ten in the third measurement and in seven in the last measurement; the microvascular flow index (MFI) for small vessels was abnormal (less than 2.6, according to the criterion described in the literature in 12 patients in the first measurement, in fourteen in the second measurement, in thirteen in the third measurement and in six in the last measurement. The large vessels showed no change in perfusion, all were in normal flow; the heterogeneity index (HI) was very high in the assessments made in patients in shock, confirming one of the main characteristics of the microcirculation in sepsis, the heterogeneity of flow.;Blood concentrations of interleukin -6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-a (TNF a) and interleukin -10 (IL-10) were higher in the septic group in three times of data collection (24h, 48h and 72h after diagnosis of septic shock or severe sepsis) in relation to the control group (p less than 0.05); blood levels of granulocyte and monocyte colony stimulating factor (GM-CSF) and interleukin-1ß (IL-1ß) were not significantly different between septic and control children. | — |
Secondary
| Measure | Time frame |
|---|---|
| Significant associations were found between oxygen consumption (VO2) and microcirculatory variables. Specifically, positive associations were observed between the difference in VO2 measurements (dVO2) and the difference between the densities of small perfused vessels (dDVPP), p less than 0.001; between dVO2 and difference between the proportions of small perfused vessels (dPVPP), p less than 0.001; VO2 and between dVO2 and difference between microvascular flow indices (dMFI), p equal to 0.001.;Significant negative correlations were observed in the proportion of small perfused vessels (PVPP%) with TNF-a at 24h (r equal to -0.1829 and p equal to 0.0293) and 48h (r equal to -0.4590 and p equal to 0.0001) ; with IL-8 at 48h (r equal to -0.2869); with IL-6 at 48h r equal to -0.3150 and p equal to 0.0053) and with IL-10 at 48h (r equal to -0.2741 and p equal to 0.0072); no significant correlations were observed between PVPP% and GM-CSF and PVPP% and IL-1ß at any of the three observation times. | — |
Countries
Brazil
Contacts
Public ContactNivaldo Villela
Outcome results
None listed