Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Ferrandiere M, Lamy F, Tellier AC, Fantin G, Lagarrigue F, Laffon M, Fusciardi J. 36th Congress of the Societe de Reanimation de Langue Francaise; January 18, 2008; Paris, France.
Introduction: NIRS (Near Infra Red Spectrometry) has proposed to be a non-invasive method to evaluate the microcirculation in patients with septic shock. Treatment of actiated drotrecogin alfa could improve the microcirculation . We have studied the oxygen saturation in septic shock patients in tissue (StO2). The data obtained via NIRS where examined via ischemic tests, prior, during and after treatment of activated drotrecogin alfa.
Materialen en methoden: Prospective research. Patients with septic shock treated with activated drotrecogin alfa. The StO2-probe (thenar eminance) and an inflating brachial cuff (upper arm) for an ischemic test (pressure of 260 mmHg). Collected data: start value StO2 (StO2), time to reach and StO2-value of 40%, recovery of StO2-value, maximum StO2-waarde (StO2 max). Calculation of the desaturation up to 40%, recovery of the saturation and the ∆StO2 [= StO2 max – StO2). Measurements where after hemodynamic stability, 4 times per day, prior to treatment of activated drotrecogin alfa, 24 en 48 hours after treatment and 4 en 24 hr after the end of the treatment.
Resultaten: Investigation of 9 patients. Data collected during 5 days. The StO2-value improved after 48 hours (88 ± 8 vs 80 ± 10% op day 0) and stayed stable afterwards. The desaturation and the ∆StO2 does not show any remarkable changes. As of 24 hours after treatment of activated drotrecogin alfa the recovery of the saturation improved faster and stays faster then the recovery of the saturation on day 0. This is also seen at 4 en 24 hr after termination of the treatment (see enclosed graph). 24 hours after treatment with activated drotrecogin alfa the recovery slows down (see enclosed graph). There was no correlation of the recovery of the saturation and the age, MAP, lactate or hemoglobin or dose of noradrenaline.
Time course of the recovery P<0,05, * vs before treatment of activated drotrecogin alfa, vs 24 hr after treatment of activated drotrecogin alfa, vs 48 hr after treatment of activated drotrecogin alfa.
Discussion: Activated drotrecogin alfa seems to influence the microcirculation. Termination of the influence the recovery slope after the ischemic test. This phenomena is also seen in patients with septic shock determined by OPS imaging (Orthogonal Polarization Spectral).
Conclusion: NIRS seems to have a valuable technique to determine and follow the problems involved with the microcirculation during septic shock. The recovery after ischemic challenge seems to be the most relevant parameter. Activated drotrecogin alfa seems to improve the microcirculation in patient with sepsis.