Microvascular function and rheologic changes in hyperdynamic sepsis

Astiz, Mark E.; DeGent, Guy E.; Lin, Robert Y.; Rackow, Eric C.

doi:10.1097/00003246-199502000-00011

Cited by 176 publications

(79 citation statements)

References 33 publications

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“…Absent reactive hyperemia has been found in adult patients in septic shock. 31,32 Other clinical methods of studying skin blood flow or skin vascular reactivity in neonates include transcutaneous Po 2 measurements and capillary refill time. Neither of the methods has been evaluated in neonatal sepsis.…”

Section: Discussionmentioning

confidence: 99%

Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-α in the Diagnosis of Early-Onset Neonatal Sepsis

2001

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ABSTRACT. Objective. To evaluate the diagnostic value of peripheral circulatory reactive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-␣ (TNF-␣) in early-onset neonatal sepsis.Methods. Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL-8, and TNF-␣ were studied in newborn infants (n ‫؍‬ 32; gestational age 39 ؎ 3 weeks) who had been admitted to the neonatal unit because of suspected sepsis <48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predetermined criteria, the infants subsequently were classified as septic (n ‫؍‬ 12) or not (n ‫؍‬ 20).Results. The degree of reactive hyperemia was higher in the group with sepsis (median ؉ 170% perfusion increase) than in that without (؉37%). On admission, serum levels of IL-6, IL-8, and TNF-␣ all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic neonates (median values: 42, 63, and 13 pg/mL, respectively). In the group with sepsis, the degree of reactive hyperemia correlated to log IL-6 (r ‫؍‬ 0.80) and log IL-8 values (r ‫؍‬ 0.71).Conclusion. Newborn infants with septicemia have increased reactive hyperemia and elevated cytokine levels very early in their disease. Reactive hyperemia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis. Pediatrics 2001;108(4). URL: http://www. pediatrics.org/cgi/content/full/108/4/e61; neonatal sepsis, newborn infant, interleukin-6, interleukin-8, TNF-␣, reactive hyperemia, diagnostic marker.ABBREVIATIONS. CRP, C-reactive protein; WBC, white blood cell count; IL-6, interleukin 6; TNF-␣, tumor necrosis factor-␣; IL-8, interleukin 8; LD, laser Doppler; PPV, positive predictive value; NPV, negative predictive value; ROC, receiver-operating characteristic curve; RDS, respiratory distress syndrome; GBS, group B streptococci. S erious infections are still causing significant morbidity and mortality among newly born infants. Immediately after birth, the clinical picture of neonatal sepsis is difficult to distinguish from more benign conditions. Rapid and reliable diagnostic tools are not yet available at the bedside. Because a delay in instituting antibiotic therapy may have adverse consequences in cases of true neonatal sepsis, in many cases decisions to treat are based on risk factors and nonspecific signs and symptoms.Experienced neonatologists and nurses recognize that in infants with sepsis, a poor peripheral circulation with a gray skin color often precedes more alarming symptoms, such as arterial hypotension and circulatory failure. Specific deviations in peripheral vascular reactivity have been found in late neonatal sepsis, 1 even before traditional markers, such as C-reactive protein (CRP) elevation and changes in white blood cell count (WBC) in peripheral blood, indicate serious infection. The advantages of...

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Section: Discussionmentioning

confidence: 99%

Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-α in the Diagnosis of Early-Onset Neonatal Sepsis

2001

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“…These mechanisms adapt to the balance between locoregional tissue oxygen transport and metabolic needs to ensure that supply matches demand. In sepsis, such a regulatory system is severely compromised because of decreased deformability of red blood cells with inherent increased viscosity (Astiz et al, 1995), an increased percentage of activated neutrophils with decreased deformability and increased aggregability due to upregulation of adhesion molecules (Linderkamp et al, 1998), activation of the clotting cascade with fibrin deposition and the formation of microthrombi (Diaz et al, 1998), dysfunction of vascular autoregulatory mechanisms (Avontuur et al, 1997), and finally, the secondary enhanced perfusion of large arteriovenous shunts (Cronenwett and Lindenauer, 1979). These heterogeneous processes result in tissue dysoxia, either from impaired microcirculatory oxygen delivery and/or from mitochondrial dysfunction (Fink, 1997;Ince, 2000).…”

Section: Microvascular Dysfunctionmentioning

confidence: 99%

Vascular biology in sepsis: pathophysiological and therapeutic significance of vascular dysfunction

Matsuda

Hattori

2007

J Smooth Muscle Res

116

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Sepsis is the leading cause of mortality in critically ill patients. In this pathological syndrome, septic shock and sequential multiple organ failure correlate with poor outcome. The pathophysiology of sepsis with acute organ dysfunction involves a highly complex, integrated response that includes activation of number of cell types, inflammatory mediators, and the hemostatic system. Central to this process may be alterations in vascular functions. This review article provides a growing body of evidence for the potential impact of vascular dysfunction on sepsis pathophysiology with a major emphasis on the endothelium. Furthermore, the role of apoptotic signaling molecules in the mechanisms underlying endothelial cell injury and death during sepsis and its potential value as a target for sepsis therapy will be discussed, which may help in the assessment of ongoing therapeutic strategies.

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“…[32][33][34] Also, fewer functional capillaries secondary to intravascular obstruction or oedema could blunt the reactive hyperemic response in critical disease. 35 The RH-index, as a measure of the peripheral circulations ability to respond to transitory local ischemia, is likely a result from all these factors. Being in part NO-dependent, the impaired RH-index at baseline could suggest a reduced endothelial NO bioavailability.…”

Section: Discussionmentioning

confidence: 99%

Inflammation and reduced endothelial function in the course of severe acute heart failure

Hermansen¹,

Kalstad²,

How³

et al. 2011

Translational Research

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Microvascular function and rheologic changes in hyperdynamic sepsis

Cited by 176 publications

References 33 publications

Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-α in the Diagnosis of Early-Onset Neonatal Sepsis

Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-α in the Diagnosis of Early-Onset Neonatal Sepsis

Vascular biology in sepsis: pathophysiological and therapeutic significance of vascular dysfunction

Inflammation and reduced endothelial function in the course of severe acute heart failure

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