Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Sales Jr J, Buchele GL, Ospina GA, Creteur J, Vincent JL. Int Care Med. 2006;32(Supp 1):S290. Abstract 1125.
Introduction: Microvascular alterations are characteristic of sepsis and may be related to outcome. Recent studies have suggested that administration of drotrecogin alfa activated (activated protein C or APC) may improve the microcirculation in sepsis.
Methods: We analyzed the microvascular response during reactive hyperemia using near-infrared spectroscopy (NIRS), in 23 patients with septic shock. Patients were separated into those who could receive APC (Group 1, N=13) and in those in whom it was contraindicated (Group 2, N=10). Tissue oxygen saturation (StiO2) was measured using NIRS (InSpectra325, Hutchinson Tech Inc, Hutchinson, MN) in the thenar eminence for three minutes after arterial occlusion. Vasoreactivity was assessed by calculation of the slope of the increase in StiO2 during the first 17.5 seconds after release of the arterial occlusion. Measurements were made daily for four days and also before and 4 hours after the administration of APC in Group 1.
Results: The slope was similar between both groups at baseline (p=0.475), however it was higher (Fig.1) in Group 1 on days 2, 3, and 4 (p=0.002, p<0.001, p<0.001, respectively). In Group 1, the slope increased significantly after 4 hours of APC administration (p=0.021) and this difference was maintained during the 4 days of infusion.
Conclusion: These observations suggest that the administration of APC improves microvascular reactivity in septic shock patients.