Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Donati A, Botticelli L, Anastasi C, Romanelli M, Romagnoli L, Beato V, Pelaia P. Crit Care. 2008;12(Supp 2):S26-S27. Abstract P67.
Introduction: In sepsis the link between the systemic inflammatory response and the development of MOF is represented by Microcirculatory and Mitochondrial Distress Syndrome (MMDS) that causes an important cellular deoxygenation not corrigible exclusively with a restoration of a normal hemodynamic state and a satisfactory systemic transport of O2. We determine the changes caused by a stagnant ischemia in the tissue oxygenation with NIRS in patient with severe sepsis, during a therapy with APC, evaluating if APC influence tissue saturation (index of O2ER) and if alterations of the hemodynamic state are connected with these changes.
Methods: Prospective observational study. We evaluate ten septic patients (treated with APC) from December 2005 to September 2007. We carried out evaluation with NIRS of the StO2 with the spectrometer InSpectra (Hutchinson Technology Inc., Minn) putting a probe of 15mm in the brachioradialis muscle of the patients. The measurements were made in 5 steps: pre-APC, at 24h, 48h, 72h, 96h and 24h after the end of the infusion (post-APC). Each measurement (of the basic StO2 and of the slope during and after the ischemia) is registered and transformed from the software InSpectra Analysis. The parameters are studied with the non-parametric test of Wilcoxon for repeated measurement (P<0,05).
Results: The increase of the basic StO2 during and after the treatment and its decrease during the arterial occlusion are statistically relevant (P<0,05). The increase of the StO2 slope after arterial occlusion is statistically relevant starting from the second day of infusion of APC (P<0,03).
Conclusions: There is an improvement of all the NIRS parameters after the infusion of APC, that is an increase of O2ER. We have to verify if that increase is connected either with a reduced shunt effect in the microcirculation or with the end of metabolic down-regulation that involves the mitochondrial system. NIRS has been used in this study for the first time, during the treatment with APC. Spectroscopy and video-microscopy focus our attention on perfusion and tissutal oxygenation, from which it’s not possible to prescind any longer during the evaluation of severity, of therapeutic choice and of treatment response of severe sepsis.
References:
1 Skarda et al. Shock 2007; 27 (4): 345-353.
2 Ince C. Critical Care 2005; 9(Suppl 4): S13-19