Microcirculation and Sepsis Treatment, Dr. Perz

Katie Perz, D.O.

Article:

Early Increases in Microcirculatory Perfusion During Protocol-Directed Resuscitation are Associated with Reduced Multi-Organ Failure at 24 hours in Patients with Sepsis

Trzeciak, S., McCoy, J., Dellinger, P., Arnold, R., Rizzuto, M, Abate, N., Shapiro, N., Parrillo, J., Hollenberg, S.,

Summary:

Sepsis is a common and lethal disease.  Development of acute multi-organ failure is one of the primary determinants of sepsis mortality.  Early evidence of multi-organ failure and early changes in organ function, specifically changes over the first 24 hours of severe sepsis presentation, are especially prognostic.  The objective of this article was to investigate whether changes in microcirculatory blood flow during the first 24 hours of sepsis are associated with changes in organ failure.  The study used direct visualization of the sublingual microcirculation with sidestream dark field (SDF) videomicroscopy to detect direct and indirect assessments of tissue perfusion.  Using this initial SDF, early goal directed therapy was initiated, and results were measured using a sequential organ failure assessment score. This score took respiration (PaO2/FiO2), coagulation (platelet levels), liver tests (bilirubin levels), cardiovascular status (hypotension or pressor use), and renal status (Creatinine levels) to evaluate the effectiveness of early goal directed therapy following microcirculation visualization with SDF videomicroscopy.

The article concluded that early increases in microcirculatory blood flow during protocol-directed resuscitation were associated with reduced organ failure at 24 hours in patients with sepsis.  The data supported the hypothesis that goal directed fluid therapy targeting the microcirculation distinct from the macrocirculation could potentially improve organ failure in sepsis.