Peripheral blood flow monitoring in an infant with septic shock

Abstract

Septic shock is associated with impaired vasoregulation, and treatment includes vasoactive drugs. Therefore, evaluation of vasoregulatory change is important. The present report describes the successful characterization of vasoregulatory change in response to a vasoactive drug during septic shock. A male infant born at 23 weeks' gestation developed septic shock. Severe hypotension developed, and treatment with colloid fluid and dopamine failed to increase blood pressure. With continuous measurement of skin blood flow using laser Doppler, noradrenaline was started. Based on changes in the blood flow, the dose was increased. At a dose of 1 μg/kg per min, skin blood flow in the foot decreased without any change in blood pressure. Subsequent blood transfusion succeeded in increasing both blood pressure and skin blood flow. It is concluded that decrease in foot blood flow reflects the vasoconstrictive effect of noradrenaline, although this finding must be validated in larger studies.

Endothelial Cell Function and Dysfunction in Critically Ill Children

“…19 A case report of an infant with septic shock found improvement in arm capillary blood flow, as measured by using sidestream spectroscopy, with improvement in macrocirculatory measures. 20 Sublingual capillary perfusion, a surrogate assessment of global microperfusion, is also disrupted in sepsis and Dengue shock. 21 Correlating the results of these techniques with levels of soluble EC adhesion molecules is also revelatory.…”

Microcirculation of the Newborn

“…Measurement of cutaneous microvascular behaviour may be more useful at identifying individuals at risk of cardiovascular compromise than traditional blood pressure monitoring, as decreases in peripheral blood flow can be identified before blood pressure drops in states of compensatory peripheral vasoconstriction. Peripheral blood flow may increase early in vasodilatory shock, despite stable systemic blood pressure for some time after onset [5]. This suggests that peripheral microvascular tissue flow evaluation may be useful for early detection of cardiovascular compromise.…”