Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Rinaldi L, Busani S, Girardis M. Int Care Med. 2006;32(Supp 1):S178. Abstract 0681.
Introduction: In septic patients, muscle tissue deoxygenation rate during stagnant ischemia is well correlated with organ failure extent and clinical outcome. Aim of this study was to evaluate the effects of recombinant humane activated Protein C (rhAPC) on muscle tissue perfusion and oxygenation during arterial clamping in patients with septic shock (1).
Methods: Prospective pilot study in a nine-bed polyvalent surgical intensive care unit of a University hospital. In 9 consecutive septic shocked patients receiving rhAPC, thenar muscle O2 saturation (StO2%) was measured by near-infrared spectroscopy (InSpectra™Hutchinson Technology Inc., USA) before, during and after a pneumatic cuff inflation at 240 mmHg. The cuff was placed above the elbow and it was deflated at an StO2 value of 40%. The rate of StO2 decreasing during ischemia as well as the time to restore baseline StO2 (re-saturation time) were calculated. Sepsis organ failure assessment score (SOFA) and the main respiratory and cardiovascular parameters were also measured. Data were collected before, during (24 hours) and 24 hours after rhAPC infusion.
Results: In all the patients, 96 hours of rhAPC therapy were completed. The infusion was temporarily stopped to allow invasive procedures in 4 patients and for minor bleeding in 1 patient. Baseline StO2 values observed before rhApc (79.88±8.5) were very similar to those observed during rhAPC infusion (79.93±11.3) and lower (p<0.05) than those observed 24 hours after the end of rhAPC (77.92±29.7). The rate of StO2 decreasing during ischemia increased by about 36% during rhAPC infusion; thereafter it returned to baseline. The re-saturation time was longer before rhAPC infusion (59.5±50.7 s) than during (43.9±27.8 s; p>0.05) and after (40.7±39.6 s; p<0.05 rhAPC therapy. The SOFA score, the respiratory and the hemodynamic parameters improved during rhAPC therapy in all the patients. The patient survival rate at 28 days after septic shock diagnosis was 66%.
Conclusion: The above preliminary data indicate that rhAPC infusion improves muscle tissue oxygenation and perfusion in septic shock patients. These variations are associated with a contemporary improvement in SOFA score.
Reference(s): 1 ) Pareznik R, Knezevic R, Voga G, Podbregar M. Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med. 2006 Jan;32:87-92.