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Impairments in microvascular reactivity are related to organ failure in human sepsis
Journal article   Open access   Peer reviewed

Impairments in microvascular reactivity are related to organ failure in human sepsis

Kevin C Doerschug, Angela S Delsing, Gregory A Schmidt and William G Haynes
American journal of physiology. Heart and circulatory physiology, Vol.293(2), pp.H1065-1071
08/2007
DOI: 10.1152/ajpheart.01237.2006
PMID: 17483235
url
https://doi.org/10.1152/AJPHEART.01237.2006View
Published (Version of record) Open Access

Abstract

Severe sepsis is a systemic inflammatory response to infection resulting in acute organ dysfunction. Vascular perfusion abnormalities are implicated in the pathology of organ failure, but studies of microvascular function in human sepsis are limited. We hypothesized that impaired microvascular responses to reactive hyperemia lead to impaired oxygen delivery relative to the needs of tissue and that these impairments would be associated with organ failure in sepsis. We studied 24 severe sepsis subjects 24 h after recognition of organ dysfunction; 15 healthy subjects served as controls. Near-infrared spectroscopy (NIRS) was used to measure tissue 1) microvascular hemoglobin signal strength and 2) oxygen saturation of microvascular hemoglobin (StO2). Both values were measured in thenar skeletal muscle before and after 5 min of forearm stagnant ischemia. At baseline, skeletal muscle microvascular hemoglobin was lower in septic than control subjects. Microvascular hemoglobin increased during reactive hyperemia in both groups, but less so in sepsis. StO2 at baseline and throughout ischemia was similar between the two groups; however, the rate of tissue oxygen consumption was significantly slower in septic subjects than in controls. The rate of increase in StO2 during reactive hyperemia was significantly slower in septic subjects than in controls; this impairment was accentuated in those with more organ failure. We conclude that organ dysfunction in severe sepsis is associated with dysregulation of microvascular oxygen balance. NIRS measurements of skeletal muscle microvascular perfusion and reactivity may provide important information about sepsis and serve as endpoints in future therapeutic interventions aimed at improving the microcirculation.
 Prospective Studies Humans Middle Aged Male Muscle, Skeletal - metabolism Sepsis - complications Case-Control Studies Microcirculation - physiopathology Forearm Spectroscopy, Near-Infrared Ischemia - complications Aged, 80 and over Adult Female Multiple Organ Failure - blood Muscle, Skeletal - blood supply Severity of Illness Index Oxygen Consumption Hemoglobins - metabolism Hyperemia - etiology Ischemia - physiopathology Sepsis - physiopathology Oxygen - blood Hyperemia - physiopathology Multiple Organ Failure - etiology Aged Sepsis - blood Multiple Organ Failure - physiopathology

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