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      Targeting the microcirculation in resuscitation of patients with septic shock: fluid is superior to norepinephrine

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      , ,
      Intensive Care Medicine Experimental
      Springer International Publishing
      ESICM LIVES 2015
      3-7 October 2015

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          Abstract

          Introduction Our goal was to examine whether fluid improve microcirculation when compared with norepinephrine in responsive septic shock patients despite early goal-directed therapy. Methods This was a single centre prospective study. Patients in septic shock for less than 24 hours despite fluid resuscitation were enrolled. Passive leg raising test was performed to predict fluid responsiveness. Responders were randomizedly divided into two groups, i.e. Resp-FL group and Resp-NE group to maintain usual MAP. In Resp-FL group, patients were treated by fluid until with no response to passive leg raising test, then the MAP was titrated to usual level by NE. In Resp-NE group, doses of NE were adjusted to maintain usual level of MAP directly. Nonresponders were enrolled in Nonresp group, MAP was titrated to usual MAP by norepinephrine. Results Twenty-four patients were enrolled, including 14 responders (7 in Resp-FL group and 7 in Resp-NE group) and 10 nonresponders. Compared with nonresponders, lactate of responders was significantly lower (2.9 ± 2.8 vs. 1.3 ± 0.7 mmol/L, p < 0.05). Compared with Nonresp group, the change of cardiac output was significantly higher in Resp-FL group and Resp-NE group (33.1 ± 28.5 vs. 28.1 ± 16.8%, p < 0.05). Compared with Resp-FL group(TVD: 30.6 ± 10.7%, PVD: 67.8 ± 58.2%, MFI: 61.5 ± 23.4%), the change of microcirculatory parameters were significantly lower of Resp-NE group (TVD: 11.1 ± 18.4%, PVD: 11.8 ± 17.2%, MFI: 15.8 ± 14.5%). Conclusions Responsiveness influenced the choice of resuscitation strategy in early septic shock patients despite early goal-directed therapy. In responders, microcirculatory improvement was found when compared fluid with norepinephrine.

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          Author and article information

          Conference
          Intensive Care Med Exp
          Intensive Care Med Exp
          Intensive Care Medicine Experimental
          Springer International Publishing (Cham )
          2197-425X
          1 October 2015
          1 October 2015
          December 2015
          : 3
          Issue : Suppl 1 Issue sponsor : The publication charges for this supplement were funded by Intensive Care Medicine Experimental.
          : A646
          Affiliations
          Southeast University, Zhongda Hospital, Nanjing, China
          Article
          787
          10.1186/2197-425X-3-S1-A646
          4797771
          a083a1f8-1fec-47f4-b96f-1a222ffcda8e
          © Xu et al.; 2015

          This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          ESICM LIVES 2015
          Berlin, Germany
          3-7 October 2015
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          Poster Presentation
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          © The Author(s) 2015

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