Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock

Becker, Leandro Quintana; Prado, Karen Fontoura; Foppa, Murilo; Martinelli, Nidiane Carla; Aguiar, Cynthia Adalgisa Mesojedovas; Furian, Thiago Quedi; Clausell, Nadine Oliveira; Rohde, Luís Eduardo Paim

doi:10.1016/j.jcrc.2011.08.002

Cited by 38 publications

(43 citation statements)

References 23 publications

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“…(16) These findings suggest an impairment of compensatory arterial vasodilation in sepsis. Moreover, compared with the survivors, a significantly higher proportion of non-survivors among the septic patients had a decline in the FMD values from the day of inclusion to the third day of follow-up.…”

Section: Discussionmentioning

confidence: 85%

Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

Nobre¹,

Ataíde²,

Brant³

et al. 2016

Revista Brasileira De Terapia Intensiva

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ObjectiveTo evaluate the usefulness and prognostic value of reactive hyperemia - peripheral arterial tonometry in patients with sepsis. Moreover, we investigated the association of reactive hyperemia - peripheral arterial tonometry results with serum levels of certain inflammatory molecules.MethodsProspective study, conducted in an 18-bed mixed intensive care unit for adults. The exclusion criteria included severe immunosuppression or antibiotic therapy initiated more than 48 hours before assessment. We measured the reactive hyperemia - peripheral arterial tonometry on inclusion (day 1) and on day 3. Interleukin-6, interleukin-10, high-mobility group box 1 protein and soluble ST2 levels were measured in the blood obtained upon inclusion.ResultsSeventeen of the 79 patients (21.6%) enrolled were determined to have reactive hyperemia - peripheral arterial tonometry signals considered technically unreliable and were excluded from the study. Thus, 62 patients were included in the final analysis, and they underwent a total of 95 reactive hyperemia - peripheral arterial tonometry exams within the first 48 hours after inclusion. The mean age was 51.5 (SD: 18.9), and 49 (62%) of the patients were male. Reactive hyperemia indexes from days 1 and 3 were not associated with vasopressor need, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, or 28-day mortality. Among the patients who died, compared with survivors, there was a significant increase in the day 3 reactive hyperemia index compared with day 1 (p = 0.045). There was a weak negative correlation between the day 1 reactive hyperemia - peripheral arterial tonometry index and the levels of high-mobility group box 1 protein (r = -0.287).ConclusionTechnical difficulties and the lack of clear associations between the exam results and clinical severity or outcomes strongly limits the utility of reactive hyperemia - peripheral arterial tonometry in septic patients admitted to the intensive care unit.

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Section: Discussionmentioning

confidence: 85%

Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

Nobre¹,

Ataíde²,

Brant³

et al. 2016

Revista Brasileira De Terapia Intensiva

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“…There are numerous human and animal studies demonstrating a correlation between inflammatory processes and endothelial dysfunction (for review see (Karbach et al, 2014a;Steven et al, 2015)). Lipopolysaccharide (LPS) from the bacterial cell wall is a strong trigger for inflammation and endothelial (vascular) dysfunction in humans (Becker et al, 2012). This occurs in severe inflammatory conditions, such as septic shock, and also in low-grade inflammatory diseases such as rheumatoid arthritis (Bergholm et al, 2002;Hansel et al, 2003) or type 2 diabetes (Henry et al, 2004), causing endothelial (vascular) dysfunction and accelerated atherosclerosis.…”

Section: Anti-inflammatory Therapymentioning

confidence: 99%

Targeting vascular (endothelial) dysfunction

Daiber

Steven

Weber

et al. 2016

British J Pharmacology

415

374

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“…However, probatory fluid loading not necessarily leads to an increase in SV; it also frequently leads to a negative fluid response, that is, SVI does not increase following this volume load (27,28). However, probatory fluid loading not necessarily leads to an increase in SV; it also frequently leads to a negative fluid response, that is, SVI does not increase following this volume load (27,28).…”

Section: Discussionmentioning

confidence: 99%

Individualized Early Goal-Directed Therapy in Systemic Inflammation

Wodack

Poppe

Tomkoetter

et al. 2014

Critical Care Medicine

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Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock

Abstract: Brachial FMD is altered in septic patients with hemodynamic instability, and its deterioration may be an early marker of unfavorable prognosis.

Cited by 38 publications

References 23 publications

Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

Targeting vascular (endothelial) dysfunction

Individualized Early Goal-Directed Therapy in Systemic Inflammation

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