Relationship Between Macrocirculation and Microcirculation Monitored By Microdialysis During Septic Shock

Meddeb, B.; Hajjej, Zied; Gharsallah, Hédi; Trabelsi, Becem; Labbène, Iheb; Ferjani, Mustapha

doi:10.1186/2197-425x-3-s1-a522

Cited by 2 publications

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“…We conducted a retrospective study in the anesthesiology and critical care department of The Military Hospital of Tunis. We analyzed the patients' database of Meddeb et al study [15]. This study was conducted from August 2011 to May 2014.…”

Section: Methodsmentioning

confidence: 99%

Microcirculatory effects of norepinephrine in patients with septic shock: a microdialysis study

Fatnassi¹,

Romdhani²,

Kaabi³

et al. 2020

Preprint

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Background: The management of septic shock requires the administration of an alpha-adrenergic drug such as norepinephrine, after optimization of the patient’s preload, to maintain adequate mean arterial pressure. Nevertheless, with optimal macrocirculatory parameters, alterations of tissue perfusion can occur. This study aimed to investigate the effect of norepinephrine dosage on microcirculation parameters, studied by microdialysis, in patients with septic shock. Methods: We conducted a retrospective study. We included all patients aged over 16 years in septic shock. We studied three groups (levosimendan, dobutamine, and control group). We administrated norepinephrine before inclusion, at stable flow for more than an hour. We performed hemodynamic monitoring of macrocirculation by echocardiography. We analyzed microcirculation parameters (lactate, pyruvate, and lactate/pyruvate ratio) every six hours during the first three days, by muscle microdialysis (CMA 600, CMA microdialysis AB, Stockholm, Sweden). We studied correlations between microcirculation parameters and norepinephrine doses.Results: We included thirty patients in the study (ten patients in each group). Demographic characteristics and mortality were comparable across the three groups. In total, we analyzed 390 samples of interstitial muscle fluid. We did not find any correlation between norepinephrine doses and the lactate concentration in the muscle, as well as the ratio of lactate/ pyruvate concentration in the muscle (p > 0.05) for all groups. We found a weak inverse correlation between norepinephrine doses and muscle pyruvate levels (p < 0.05) for the dobutamine group and the control group and but not for the levosimendan group.Conclusions: Noradrenaline dose has little effect on microcirculation when administered for hemodynamic optimization, as recommended by the Surviving Sepsis Campaign.

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Section: Methodsmentioning

confidence: 99%