Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study

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dc.contributor.authorHernández P., Glenn
dc.contributor.authorRegueira Heskia, Tomás
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorCastro López, Ricardo
dc.contributor.authorRovegno Echavarria, Maxiliano
dc.contributor.authorFuentealba, Andrea
dc.contributor.authorVeas, Enrique
dc.contributor.authorFlorez, Jorge
dc.contributor.authorKattan Tala, Eduardo José
dc.contributor.authorMartin, Celeste
dc.contributor.authorInce, Can
dc.contributor.authorBerrutti, Dolores
dc.date.accessioned2019-10-17T18:22:42Z
dc.date.available2019-10-17T18:22:42Z
dc.date.issued2012
dc.date.updated2019-10-14T19:16:16Z
dc.description.abstractAbstract Background Recent clinical studies have confirmed the strong prognostic value of persistent hyperlactatemia and delayed lactate clearance in septic shock. Several potential hypoxic and nonhypoxic mechanisms have been associated with persistent hyperlactatemia, but the relative contribution of these factors has not been specifically addressed in comprehensive clinical physiological studies. Our goal was to determine potential hemodynamic and perfusion-related parameters associated with 6-hour lactate clearance in a cohort of hyperdynamic, hyperlactatemic, septic shock patients. Methods We conducted an acute clinical physiological pilot study that included 15 hyperdynamic, septic shock patients undergoing aggressive early resuscitation. Several hemodynamic and perfusion-related parameters were measured immediately after preload optimization and 6 hours thereafter, with 6-hour lactate clearance as the main outcome criterion. Evaluated parameters included cardiac index, mixed venous oxygen saturation, capillary refill time and central-to-peripheral temperature difference, thenar tissue oxygen saturation (StO2) and its recovery slope after a vascular occlusion test, sublingual microcirculatory assessment, gastric tonometry (pCO2 gap), and plasma disappearance rate of indocyanine green (ICG-PDR). Statistical analysis included Wilcoxon and Mann–Whitney tests. Results Five patients presented a 6-hour lactate clearance <10%. Compared with 10 patients with a 6-hour lactate clearance ≥10%, they presented a worse hepatosplanchnic perfusion as represented by significantly more severe derangements of ICG-PDR (9.7 (8–19) vs. 19.6 (9–32)%/min, p < 0.05) and pCO2 gap (33 (9.1-62) vs. 7.7 (3–58) mmHg, p < 0.05) at 6 hours. No other systemic, hemodynamic, metabolic, peripheral, or microcirculatory parameters differentiated these subgroups. We also found a significant correlation between ICG-PDR and pCO2 gap (p = 0.02). Conclusions Impaired 6-hour lactate clearance could be associated with hepatosplanchnic hypoperfusion in some hyperdynamic septic shock patients. Improvement of systemic, metabolic, and peripheral perfusion parameters does not rule out the persistence of hepatosplanchnic hypoperfusion in this setting. Severe microcirculatory abnormalities can be detected in hyperdynamic septic shock patients, but their role on lactate clearance is unclear. ICG-PDR may be a useful tool to evaluate hepatosplanchnic perfusion in septic shock patients with persistent hyperlactatemia. Trial registration ClinicalTrials.gov Identifier: NCT01271153
dc.fuente.origenBiomed Central
dc.identifier.citationAnnals of Intensive Care. 2012 Oct 15;2(1):44
dc.identifier.doi10.1186/2110-5820-2-44
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/26844
dc.issue.numeroNo.44
dc.language.isoen
dc.pagina.final9
dc.pagina.inicio1
dc.revistaAnnals of Intensive Carees_ES
dc.rightsacceso abierto
dc.rights.holderHernandez et al.; licensee Springer.
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.otherInsuficiencia cardíacaes_ES
dc.subject.otherShock sépticoes_ES
dc.subject.otherÁcido lácticoes_ES
dc.titleRelationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot studyes_ES
dc.typeartículo
dc.volumenVol.2
sipa.codpersvinculados98874
sipa.codpersvinculados18434
sipa.codpersvinculados741
sipa.codpersvinculados4537
sipa.codpersvinculados1004053
sipa.codpersvinculados98281
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