Microcirculatory Oxygen Uptake in Sepsis
Maneno muhimu
Kikemikali
Maelezo
Sepsis remains a common entity in critical care patients with remarkable mortality. Microcirculatory dysfunction plays a pivotal role in the pathophysiology of sepsis and organ dysfunction. The main causal mechanisms are vasoactive substances such as nitric oxide and endothelin, destroyed endothelial surfaces and microvascular occlusion by activated coagulation and leucocytes. Furthermore there is some knowledge from vasooclussive testing (VOT) based on near-infrared spectroscopy (NIRS) and assessing the proportion of perfused vessels determined with orthogonal polarization spectral and sidestream darkfield imaging techniques (SDF) that impaired microcirculation is associated with organ dysfunction and increased mortality. Despite these well-recognised evidence previous trails proving therapy guidance with microcirculatory parameters failed in demonstrating optimised outcome . Recent guidelines still recommend fluid therapy based on central venous pressure, mean arterial pressure, urine output and or blood lactate concentration. But especially the parameter central venous oxygen saturation (ScvO2) seems to be not unproblematic. Retrospective data analysis found higher mortality rates if ScvO2 is elevated.
In the present study patients with sepsis, severe sepsis and septic shock will be evaluated on day 1 and day 4 and a follow up will be performed on day 180.
Additional to clinical parameters of organ function, infection markers, global parameters of tissue hypoxia will be captured by measurements of adenosine and whose metabolites.
Macrocirculatory cardiovascular function delivered by transpulmonary thermodilution technique will be assessed and local tissue perfusion and oxygen uptake will be measured with a transcutaneous laser-doppler spectrophotometry system in VOT.
The aim of this study is to check:
1. Is microcirculatory oxygen uptake a prognostic value in sepsis?
2. Is it correlated with biomarkers of hypoxia?
3. Are high levels of ScvO2 caused by microcirculatory impairments or by hyperdynamic macrocirculation?
Tarehe
| Imethibitishwa Mwisho: | 04/30/2018 |
| Iliyowasilishwa Kwanza: | 04/15/2015 |
| Uandikishaji uliokadiriwa Uliwasilishwa: | 04/24/2015 |
| Iliyotumwa Kwanza: | 04/29/2015 |
| Sasisho la Mwisho Liliwasilishwa: | 04/30/2018 |
| Sasisho la Mwisho Lilichapishwa: | 05/01/2018 |
| Tarehe halisi ya kuanza kwa masomo: | 03/31/2015 |
| Tarehe ya Kukamilisha Msingi iliyokadiriwa: | 09/30/2016 |
| Tarehe ya Kukamilisha Utafiti: | 07/31/2017 |
Hali au ugonjwa
Uingiliaji / matibabu
Other: Vasoocclusive testing
Awamu
Vikundi vya Arm
| Mkono | Uingiliaji / matibabu |
|---|---|
| Vasoocclusive testing in sepsis Septic patients defined according to the Surviving Sepsis Campaign (SSC) | |
| Vasoocclusive testing in severe sepsis Severe septic patients defined according to the Surviving Sepsis Campaign (SSC) | |
| Vasoocclusive testing in sepsic shock Septic shock patients defined according to the Surviving Sepsis Campaign (SSC) |
Vigezo vya Kustahiki
| Zama zinazostahiki Kujifunza | 18 Years Kwa 18 Years |
| Jinsia Inastahiki Kujifunza | All |
| Njia ya sampuli | Probability Sample |
| Hupokea Wajitolea wa Afya | Ndio |
| Vigezo | Inclusion Criteria: - Criteria according to the SSC for sepsis, severe sepsis and septic shock - Admission to the ICU within 24 hours Exclusion Criteria: - Pregnancy - Cardiopulmonary resuscitation within the last 5 days |
Matokeo
Hatua za Matokeo ya Msingi
1. Overall Survival [180 days]
Hatua za Matokeo ya Sekondari
1. Connection between ScvO2 and microcirculatory oxygen uptake [Day 1 and day 4]
2. Connection between adenosine-metabolites and microcirculatory oxygen uptake [Day 1 and day 4]
3. Physical condition [180 days]
