Please see Bibliography of References for a list of abstracts, manuscripts and posters.

Microvascular Dysfunction

Impact of time on systemic and local evaluation of perfusion/oxygenation during septic shock

Heyer L, Madadaki K, Rezlan E, Mateo J, Losser MR, Payen D. Int Care Med. 2005;31(Supp 1):S16. Abstract 044.

Objective: study the relation between systemic and local perfusion indexes in septic shock patients.

Setting and Design: A prospective study in a 15-bed surgical ICU.

Materials and Methods: 7 consecutive septic shock patients sedated and mechanically ventilated were studied (mean SOFA score: 11,5 [8 - 16]). Systemic parameters: BPsyst; BPdiast, SvO2 central (ScvO2), central temperature (Tc); local parameters: local thenar skin temperature (Tskin), static tissue oxygenation of thenar skeletal muscle (StO₂), dynamic tissue oxygenation (NIRS) following forearm arterial occlusion: the slope of the decrease in StO₂ saturation during occlusion as an index of local tissue oxygen consumption. Measurements at T0: time of ICU admission; T1: after 24hrs; and T2: before ICU discharge.

Results: from T0 to T1, systemic parameters did not change with a large gradient between central temperature and thenar skin temperature (9 degrees) which decreased at T1 to 3 degrees (p<0.05) (Fig left). The slope of StO₂ during occlusion was slower at T1 than T0 (p<0.05) and StO₂ baseline value was higher at T1 than T0 (p<0.05) suggesting a reduction in local O₂ oxygen consumption (Fig right).

Conclusion: time evolution: the association between reduction in temperature gradient and an occlusion slower slope of StO₂ decrease suggests an improvement in tissue perfusion after resuscitation (temp gradient reduction) associated with a reduction in tissue O₂ consumption after 24 hrs. Local modifications along time were more pronounced than systemic modifications in acute phase.