|
1
|
Collet M, Huot B, Barthélémy R, Damoisel C, Payen D, Mebazaa A, Chousterman BG. Influence of systemic hemodynamics on microcirculation during sepsis. J Crit Care 2019; 52:213-218. [PMID: 31102939 DOI: 10.1016/j.jcrc.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/07/2019] [Accepted: 05/01/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE During sepsis, improvement of hemodynamic may not be related to improvement of microcirculation. The aim of this study was to investigate influence of systemic circulation on microcirculation in septic ICU patients. METHODS This is a prospective cohort study of septic ICU patients. Microcirculation was investigated with Near infrared spectrometry (NIRS) measuring tissue oxygen saturation (StO2). StO2 desaturation (desStO2) and resaturation (resStO2) slopes were determined. Analyses were made at baseline and after fluid challenges. RESULTS Seventy-two patients were included. One hundred and sixty measures were performed at baseline. StO2 was 77.8% [72.4-85.0] and resStO2 was 87.3%/min [57.8-141.7]. Univariate analysis showed an association between resStO2 and diastolic arterial pressure (DAP) (p = .001), and norepinephrine dose (p = .033). In multivariate linear regression, there was an association between resStO2 and DAP (β = 1.85 (0.64 to 3.08), p = .004). Fluid challenges (n = 60) increased CO, and resStO2 (all p < .001). In multivariate analysis, variation of stroke volume was associated with variation of resStO2 (p = .004) after fluid challenge. There was no association between CVP and resStO2. CONCLUSIONS DAP was the only independent determinant of resStO2 in septic patients. Fluid challenges may improve microcirculation. CVP did not influence resStO2.
Collapse
Affiliation(s)
- Magalie Collet
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Benjamin Huot
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Charles Damoisel
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Didier Payen
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U942, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| |
Collapse
|
|
2
|
Hackenhaar FS, Medeiros TM, Heemann FM, Behling CS, Putti JS, Mahl CD, Verona C, da Silva ACA, Guerra MC, Gonçalves CAS, Oliveira VM, Riveiro DFM, Vieira SRR, Benfato MS. Therapeutic Hypothermia Reduces Oxidative Damage and Alters Antioxidant Defenses after Cardiac Arrest. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:8704352. [PMID: 28553435 PMCID: PMC5434234 DOI: 10.1155/2017/8704352] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
After cardiac arrest, organ damage consequent to ischemia-reperfusion has been attributed to oxidative stress. Mild therapeutic hypothermia has been applied to reduce this damage, and it may reduce oxidative damage as well. This study aimed to compare oxidative damage and antioxidant defenses in patients treated with controlled normothermia versus mild therapeutic hypothermia during postcardiac arrest syndrome. The sample consisted of 31 patients under controlled normothermia (36°C) and 11 patients treated with 24 h mild therapeutic hypothermia (33°C), victims of in- or out-of-hospital cardiac arrest. Parameters were assessed at 6, 12, 36, and 72 h after cardiac arrest in the central venous blood samples. Hypothermic and normothermic patients had similar S100B levels, a biomarker of brain injury. Xanthine oxidase activity is similar between hypothermic and normothermic patients; however, it decreases posthypothermia treatment. Xanthine oxidase activity is positively correlated with lactate and S100B and inversely correlated with pH, calcium, and sodium levels. Hypothermia reduces malondialdehyde and protein carbonyl levels, markers of oxidative damage. Concomitantly, hypothermia increases the activity of erythrocyte antioxidant enzymes superoxide dismutase, glutathione peroxidase, and glutathione S-transferase while decreasing the activity of serum paraoxonase-1. These findings suggest that mild therapeutic hypothermia reduces oxidative damage and alters antioxidant defenses in postcardiac arrest patients.
Collapse
Affiliation(s)
- Fernanda S. Hackenhaar
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Tássia M. Medeiros
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Fernanda M. Heemann
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Camile S. Behling
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Jordana S. Putti
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Camila D. Mahl
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Cleber Verona
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
- Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Ana Carolina A. da Silva
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| | - Maria C. Guerra
- Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Brazil
| | | | | | | | | | - Mara S. Benfato
- Departamento de Biofísica, UFRGS, Porto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular, UFRGS, Porto Alegre, Brazil
| |
Collapse
|
|
3
|
Fouche PF, Carlson JN, Ghosh A, Zverinova KM, Doi SA, Rittenberger JC. Frequency of adjustment with comorbidity and illness severity scores and indices in cardiac arrest research. Resuscitation 2017; 110:56-73. [DOI: 10.1016/j.resuscitation.2016.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/04/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022]
|