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

2020 ◽  
Author(s):  
Amira Fatnassi ◽  
Chihebeddine Romdhani ◽  
Widd Kaabi ◽  
Iheb Labbene ◽  
Zied Hajjej ◽  
...  
Keyword(s):  
Septic Shock ◽  
Lactate Concentration ◽  
Inverse Correlation ◽  
Tissue Perfusion ◽  
Control Group ◽  
Adrenergic Drug ◽  
Microdialysis Study ◽  
And Control ◽  
Stable Flow ◽  
Pyruvate Ratio

Abstract 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.

scholarly journals Association between Doppler snuffbox resistive index and tissue perfusion in septic patients

2020 ◽  
Author(s):  
Cui Wang ◽  
xiaoting wang ◽  
Hongmin Zhang ◽  
Wei Huang ◽  
Dawei Liu
Keyword(s):  
Septic Shock ◽  
Resistive Index ◽  
Tissue Perfusion ◽  
Lactate Clearance ◽  
Control Group ◽  
Tissue Hypoperfusion ◽  
Critical Ill Patients ◽  
The Status ◽  
And Control ◽  
Better Than

Abstract Background: Doppler snuffbox resistive index (SBRI) can be a accurate parameter at the bedside to evaluate the status of peripheral vascular. We evaluated whether SBRI could relate to tissue hypoperfusion and could predict lactate clearance in septic patients. Methods: We conducted a prospective observational study in a tertiary general and teaching hospital in China.From July 2019 to Decemeber 2019,all consecutive adult patients with septic shock who required ICU admission were included. At the same time,postoperative patients were studied as a control group.we recorded the hemodynamic parameters including SBRI and PI which were measured simultaneously after involved . Results: We evaluated 44 patients with septic shock in study group and 20 stable postoperative patients in control group. Patients with septic shock had higher SOFA scores,PCT, CI and lactate than patients in control group.The SBRI was correlated with PI and lactate. The CI was not correlated with lactate in all patients.Based on Lactate clearance in first 6 hours, the septic shock patients were divided into the Lactate clearance ≥20% or the Lactate clearance <20% group.CI is no significal difference between two groups.SBRI of the Lactate clearance <20% group is higher than Lactate clearance≥20% group and control group.PI of the Lactate clearance <20% group is lower than Lactate clearance≥20% group and control group.The cutoff of the SBRI value was ≥1.09 for predicting 6h-lactate clearance after resuscitation, resulting in a sensitivity of 68.8% and a specificity of 85.7%. The cutoff of the PI value was ≤0.99 for predicting 6h-lactate clearance after resuscitation, resulting in a sensitivity of 64.3% and a specificity of 81.2%. The SBRI was significantly better than the PI for predicting 6h-lactate clearance after resuscitation. Conclusions: SBRI is correlated with tissue perfusion parameters in critical ill patients. Abnormal SBRI was better than PI in suggesting disorder of lactate clearance of septic patients. SBRI is a better indicator of abnormal tissue perfusion than CI. Further investigations are required to determine whether the correction of abnormal SBRI and PI may improve success rate of resuscitation of septic shock.

Optimal Adrenergic Support in Septic Shock Due to Peritonitis

2003 ◽  
Vol 98 (4) ◽  
pp. 888-896 ◽  
Author(s):  
Qinghua Sun ◽  
Zizhi Tu ◽  
Suzana Lobo ◽  
George Dimopoulos ◽  
Nathalie Nagy ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
The Other ◽  
Control Group ◽  
Lower Blood

Background The authors evaluated optimal adrenergic support using norepinephrine, dopamine, and dobutamine in a clinically relevant model of septic shock. Methods Twenty-eight mature, female, anesthetized sheep (weight, 30.5 +/- 3.6 kg) underwent cecal ligation and perforation and were randomized into four groups of seven animals to be treated with norepinephrine, dopamine-norepinephrine, dobutamine-norepinephrine, or no adrenergic agent. In all groups, lactated Ringer's solution was administered to restore cardiac filling pressures to baseline. In the norepinephrine group, norepinephrine (0.5-5 microg. kg(-1). min(-1)) was titrated to maintain mean arterial pressure between 75-85 mmHg. In the dopamine-norepinephrine group, dopamine was given first, and norepinephrine was added only when mean arterial pressure remained below 75 mmHg despite the infusion of 20 microg. kg(-1). min(-1) dopamine. In the dobutamine-norepinephrine group, dobutamine was started at the same time as norepinephrine and titrated up to 20 microg. kg(-1). min(-1) to get a 15% increase in cardiac output. Results The dobutamine-norepinephrine group had greater cardiac output; superior mesenteric blood flow, oxygen delivery (Do(2)), and oxygen consumption ([OV0312]o(2)); and lower blood lactate concentration and partial pressure of carbon dioxide (Pco(2)) gap than the controls did. Cumulative urine output was significantly higher in the dobutamine-norepinephrine group than in the other groups. Survival time was significantly longer in the dobutamine-norepinephrine (24 +/- 4 h), dopamine- norepinephrine (24 +/- 6 h), and norepinephrine (20 +/- 1 h) groups than the control group (17 +/- 2 h; P &lt; 0.05 vs. other groups), and significantly longer in the combined dopamine-norepinephrine and dobutamine-norepinephrine groups (24 +/- 5 h) than in the norepinephrine alone group (P &lt; 0.05). Histologic examination of lung biopsies revealed less severe lesions in the dobutamine-norepinephrine group than in the control and norepinephrine alone groups. Anatomic alterations in the lung, liver, and small intestine were less severe in the dobutamine-norepinephrine group than in the other groups. Conclusions In this prolonged septic shock model, association of norepinephrine with either dopamine or dobutamine resulted in the longest survival and the least severe pulmonary lesions. The combination of dobutamine with norepinephrine was associated with a better myocardial performance, greater Do(2) and [OV0312]o(2), lower blood lactate concentration and Pco(2) gap, and less anatomic injury.

scholarly journals The Potential of Walnut Oil with Massage Effleurage to Prevent Grade 1 Decubitus Wounds of Bed Rest Patients

2021 ◽  
Vol 8 (3) ◽  
pp. 309-314
Author(s):  
Iis Noventi ◽  
Umdatus Soleha ◽  
Siti Nur Hasina
Keyword(s):  
Pressure Ulcers ◽  
Bed Rest ◽  
Tissue Perfusion ◽  
Control Group ◽  
P Value ◽  
Walnut Oil ◽  
Skin Integrity ◽  
Quasi Experimental ◽  
Pulling Force ◽  
And Control

The main problem in decubitus patients is the risk of damage to skin integrity related to factors: immobility, decreased sensory perception, decreased tissue perfusion, decreased nutritional status, friction and pulling force, advanced age, and increased humidity. The decubitus is a problem faced by patients with chronic diseases, weak conditions, and patients who experience paralysis. This study aimed to analyze the potential of walnut oil in preventing grade 1 decubitus Wounds of bed Rest Patients. This study used a Quasi-Experimental design (pretest-posttest control group). The sample was 20 people, divided into 2 groups; treatment and control. The treatment group received effleurage massage with walnut oil given twice a day for 7 days, while the control group received pressure ulcers prevention treatment according to the SOP applied in the hospital. A total of 10 patients who received massage using walnut oil showed a p-value of 0.04 (<0.05), which meant that walnut oil massage was affected significantly in preventing pressure ulcers. In conclusion, decubitus wounds can be prevented by effleurage massage with walnut oil which is given regularly twice a day.

scholarly journals Acute hypoxic hypoxia increases lactate concentration in amniotic fluid of rabbits on 27-28th day of pregnancy

2017 ◽  
Vol 63 (1) ◽  
pp. 81-84
Author(s):  
A.V. Popovtseva ◽  
E.V. Suzopov ◽  
Yu.V. Korenovsky
Keyword(s):  
Amniotic Fluid ◽  
Lactate Level ◽  
Biochemical Composition ◽  
Lactate Concentration ◽  
Late Pregnancy ◽  
Hypoxic Hypoxia ◽  
Control Group ◽  
Acute Hypoxic Hypoxia ◽  
And Control ◽  
High Lactate

We evaluated the influence of hypoxic hypoxia on lactate, creatinine and urea concentrations in the amniotic fluid (AF) of rabbits on 27-28th day of pregnancy. Rabbits were randomly sudivided into two groups: experimental (n=9) and control (n=6). Rabbits of experimental groups were placed in a hypoxic chamber containing 10±2% oxygen and 90±2% nitrogen for 1 h and then were euthanized, AF was extracted from the amniotic sacs via disposable syringe. Acute hypoxic hypoxia had no effect on the AF volume, increased (1.4-fold) lactate, (1.3-fold) creatinine and (1.1-fold) urea concentrations in AF. In contrast to animals of the control group, lactate concentration in the groups with hypoxic hypoxia correlated with the creatinine (r=0.71, p<0.0001, n=35) and urea concentrations in the AF (r=0.81, p<0.0001, n=35). These results suggest that acute hypoxic hypoxia in late pregnancy causes changes in the biochemical composition of AF; these changes are characterized by high lactate concentrations, and the fetus and uterus can be the source of increased lactate level in AF.

scholarly journals Impact of Vitamin C and Thiamine Administration on Delirium-Free Days in Patients with Septic Shock

2020 ◽  
Vol 9 (1) ◽  
pp. 193 ◽  
Author(s):  
Jong Eun Park ◽  
Tae Gun Shin ◽  
Ik Joon Jo ◽  
Kyeongman Jeon ◽  
Gee Young Suh ◽  
...  
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Vitamin C ◽  
Control Group ◽  
Matched Pairs ◽  
Control Groups ◽  
Icu Delirium ◽  
Definition Of ◽  
And Control ◽  
The Impact

Sepsis is a common cause of delirium in the intensive care unit (ICU). Recently, vitamin C and thiamine administration has been gaining interest as a potential adjunct therapy for sepsis. We investigated the impact of early vitamin C and thiamine administration on ICU delirium-free days among critically ill patients in septic shock. We performed a single-center, retrospective study of patients who visited the emergency department (ED) from January 2017 to July 2018. We categorized patients into a treatment (received vitamin C and thiamine) and control group. We compared delirium-free days within 14 days after ICU admission using propensity score matching. Of 435 patients with septic shock, we assigned 89 propensity score-matched pairs to the treatment and control groups. The median delirium-free days did not differ between treatment (11, interquartile range [IQR] 5–14 days) and control (12, IQR 6–14 days) groups (p = 0.894). Secondary outcomes were not different between the two groups, including delirium incidence and 28-day mortality. These findings were consistent after subgroup analysis for patients who met the sepsis-3 definition of septic shock. Vitamin C and thiamine administration showed no association with ICU delirium-free days among patients in septic shock.

scholarly journals Effects of a High Dose of Vitamin C along with Thiamine in Critically-ill Patients with Septic Shock: A Preliminary Study

2019 ◽  
pp. 1-7
Author(s):  
Hasanali Karimpour ◽  
Alireza Bahrami ◽  
Shila Amini ◽  
Mansour Rezaei ◽  
Javad Amini-Saman ◽  
...  
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Lactate Concentration ◽  
Intervention Group ◽  
Treatment Modalities ◽  
Control Group ◽  
High Dose

Septic shock may occur in critically ill patients and despite antimicrobial treatment, it is associated with a high mortality rate. It is reasonable to look for new treatment modalities that might improve outcome. This is a randomized, double-blind control trial aiming at critically-ill septic patients in a tertiary hospital. Patients with quick sofa score of 2 and with organ dysfunction were included in this study. The intervention group received high doses of vitamin C at a dose of 50 mg/kg/four times daily along with thiamine at a dose of 200 mg/ twice daily) and the control group received normal saline for four days. The dose of vasopressors, procalcitonin and lactate clearance, and mean sequential organ failure assessment (SOFA) score were examined in the two groups. Patients were followed for 28 days. One hundred patients were allocated into two equal groups, and there was no difference between the two groups regarding baseline characteristics. Mean lactate concentration, SOFA score, days of antimicrobial therapy, and mortality at 28 days were similar between them. However, the mean procalcitonin concentration, and mean vasopressor treatment hours were significantly lower in the intervention group (p<0.05). Although Days of ICU stay were lower in the intervention group, It did not reach statistical significance. The results of this study showed that treatment with high dose vitamin C Reduces the vasopressor requirement without any effects on other parameters. Further studies with larger sample size are required for more generalizable results.

scholarly journals Effects of dexmedetomidine on renal function in patients with septic shock

2018 ◽  
Vol 16 ◽  
pp. 205873921879406
Author(s):  
Lvlin Chen ◽  
Ying Lan ◽  
Jun-Cheng Zhu ◽  
Yan He
Keyword(s):  
Septic Shock ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Control Group ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Tnf Α ◽  
And Control ◽  
Experimental Group ◽  
Necrosis Factor

This study was to observe the effects of dexmedetomidine against acute kidney injury in patients with septic shock. A prospective randomized controlled trial (RCT) was conducted in which 80 patients with septic shock admitted in Department of Critical Care Medicine of the Affiliated Hospital of Chengdu University from June 2015 to January 2017 were divided into experimental group and control group. The patients in both groups received basic treatment for septic shock, and the patients in the experimental group were given intravenous injection of dexmedetomidine, maintained with 0.1–0.2 µg kg−1 h−1 for 5 days. In both groups, the changes in the levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, serum creatinine (SCr), cystatin C (Cys C), and β2-microglobulin (β2-MG) were determined before treatment and 1, 3, and 5 days after treatment. At 5 days after treatment, Cys C, β2-MG, and SCr were significantly decreased in both groups ( P < 0.05), and the degree of decrease in the experimental group was more obvious ( P < 0.05). At 1, 3, and 5 days after treatment, IL-6 and TNF-α were significantly decreased in both groups ( P < 0.05) and the degree of decrease in the experimental group was more obvious ( P < 0.05). Dexmedetomidine has certain renal protective effect in patients with septic shock, and its mechanism is possibly related to the regulation and improvement of uncontrolled inflammatory response.

scholarly journals Relevance of lactate level detection in migrane and fibromyalgia

2019 ◽  
Vol 29 (2) ◽  
Author(s):  
Patrizia Proia ◽  
Alessandra Amato ◽  
Valentina Contrò ◽  
Alessandra Lo Monaco ◽  
Jessica Brusa ◽  
...  
Keyword(s):  
Postural Stability ◽  
Path Length ◽  
Lactate Concentration ◽  
Control Group ◽  
Eyes Closed ◽  
Dynamic Coordination ◽  
Eyes Open ◽  
Lactate Levels ◽  
And Control ◽  
Blood Lactate Levels

The aim of this study was to determine the blood lactate levels in healthy and pathological subjects, particularly with migraine and fibromyalgia. Moreover we investigated the possible correlation between lactate concentration, postural stability and balance disorders; the composition of the groups were: migraine (n = 25; age 49.7 ± 12.5), fibromyalgia (n = 10; age 43.7 ± 21.2), control group (n = 16 age 28.52 ± 2.4). The results showed that patients with fibromyalgia (FG) had higher lactate levels compared to migraine (MG) and control group (CG) (mean ± sd: FG = 1.78 ± 0.9 mmol/L; MG = 1.45±1 mmol/L; CG = 0,85 ± 0,07 mmol/L). The same situation was highlighted about the sway path length with eyes closed (FG = 518 ± 195 mm; MG = 465 ± 165 mm; CG = 405 ± 94,72 mm) and with eyes open (FG = 430 ± 220 mm; MG = 411 ± 143 mm; CG = 389 ± 107 mm). This can be explained by the fact that energy-intensive postural strategies must be used to optimize both static and dynamic coordination, in particular with repeated contractions of tonic oxidative muscle cells responsible for postural control.

scholarly journals Unexplained mortality differences between septic shock trials: a systematic analysis of population characteristics and control-group mortality rates

2018 ◽  
Vol 44 (3) ◽  
pp. 311-322 ◽  
Author(s):  
Harm-Jan de Grooth ◽  
Jonne Postema ◽  
Stephan A. Loer ◽  
Jean-Jacques Parienti ◽  
Heleen M. Oudemans-van Straaten ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mortality Rates ◽  
Population Characteristics ◽  
Control Group ◽  
Systematic Analysis ◽  
And Control

scholarly journals Metabolic resuscitation therapy in critically Ill patients with sepsis and septic shock: A Prospective Randomized Controlled Trial

2021 ◽  
Author(s):  
Fang Feng ◽  
Huyong Yang ◽  
Weiwei Yang ◽  
Min Li ◽  
Yu Chen
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trial ◽  
Mortality Rate ◽  
Controlled Trial ◽  
Control Group ◽  
Icu Mortality ◽  
Randomized Controlled ◽  
Sepsis And Septic Shock ◽  
And Control ◽  
Experimental Group

Abstract ObjectiveTo further clarify the effectiveness and potential pathophysiological principles of metabolic resuscitation therapy in critically ill patients with sepsis and septic shock.MethodsProspective randomized controlled trial. Patients with sepsis and septic shock who were admitted to the ICU from Sep. 2019 to Mar. 2020 were prospectively enrolled. According to the computerized random sequence table, patients were randomly divided into the experimental group and the control group. All patients with sepsis were included in the research of cluster of initial therapy. The experimental group received metabolic resuscitation: vitamin C (1.5 g in an intravenous infusion q6h for 3 days), vitamin B1 (200 mg in an intramuscular injection q12h for 3 days), and hydrocortisone (50 mg in an intravenous infusion q6h for 7 days).ResultsOne hundred thirty-six patients with sepsis and septic shock were included in our study. Pneumonia was the main cause of sepsis and septic shock, including 33 (49%) and 41 (60%) patients in the experimental group and control group, respectively, and gram-negative bacilli were the main pathogenic bacteria (112/136, 82.4%). The ICU length of stay for the experimental group and the control group was 9 (7–12) and 11 (9–14) days, respectively, P = 0.002. The duration of vasoactive drugs (hours) was 20.8 ± 9.9 and 46.7 ± 12.8, respectively, P༜0.001. The 6-hour lactate clearance rate was 66.2% (55.5, 76.7) and 30.1% (15.6, 50) in the experimental group and control group, respectively, P = 0.000. The 72-hour PCT clearance rate was 70% (57.5, 80.3) and 40.7% (24.8, 52.2), respectively, P = 0.001. The ICU mortality rate was 8.8% (6/68) and 15% (15/68), respectively, P = 0.033.ConclusionsMetabolic resuscitation therapy is beneficial for patients with sepsis and septic shock, shortening the length of ICU stay, reducing the duration of vasopressor use, and reducing the ICU mortality rate of patients with sepsis and septic shock. However, large, multi-center, prospective randomized controlled trials are needed to further verify these results.Trial registrationChiCTR, ChiCTR1900026084. Registered 20 September 2019 - prospective registered, http://www.chictr.org.cn/edit.aspx?pid=40910&htm=4

Sign in / Sign up

Export Citation Format

Share Document