Clinical relevance of early sublingual microcirculation monitoring in septic shock patients

Article type: Research Article

Authors: Sharawy, Nivin^{a; b; c; *} | Mahrous, Reham^a | Whynot, Sara^c | George, Ronald^c | Lehmann, Christian^{c; d; e}

Affiliations: [a] Department of Anaesthesia, Surgical Intensive Care Trauma Center, Faculty of Medicine, Cairo University, Cairo, Egypt | [b] Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt | [c] Department of Anaesthesia, Pain Management and Perioperative Medicine’s, Faculty of Medicine, Dalhousie University, Halifax, Canada | [d] Department of Pharmacology, Faculty of Medicine, Dalhousie University, Halifax, Canada | [e] Department of Immunology, Faculty of Medicine, Dalhousie University, Halifax, Canada

Correspondence: [*] Corresponding author: Nivin Sharawy, MD, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H 2Y9, Canada; Kasr El-Aini, Cairo University, Al-Saray Street, 11562 Cairo, Egypt. Tel.: +902 401 2942/01122433182; E-mail: [email protected].

Abstract: INTRODUCTION:Although microcirculation dysfunction plays unique role in septic shock, translation of microcirculation to clinical practices is limited by current semi-quantities analysis and unclear clinical relevance of microcirculation monitoring. Our aim was to critically evaluate the characteristic nature and relevant clinical important of microcirculation. EVIDENCE ACQUISITION:Pubmed (2000 to August 2015) were searched to identify observation, case-control, intervention and randomized clinical studies evaluating the relationship between microcirculation alterations and mortality, morbidity and drug responses. The STROBE and CONSORT Statement for assessment of the quality of included studies. EVIDENCE SYNTHESIS:We examined results from 17 observations, 4 randomized controlled trials and one case report published studies. This data set comprised of 637 patients. Early septic shock is associated with hypoperfusion and heterogeneous microcirculation that is associated with hyperlactemia and metabolic acidosis. The evidence on clinical relevance of microcirculation is less striking, mainly due to the limited number of studies and problems related to the methodological protocol of the studies and currently semi-quantitative analysis technique. In particular the baseline and time course of microcirculation alteration appears to be controversial. CONCLUSION:There is lack of evidences of clinical importance of early microcirculation monitoring and mechanism of microcirculation dysfunction in septic shock patients. This could be due to the methodological protocol of the studies and currently semi-quantitative analysis technique.

Keywords: Septic shock, tissue perfusion, organ dysfunction, drug response, hemodynamic

DOI: 10.3233/CH-170244

Journal: Clinical Hemorheology and Microcirculation, vol. 68, no. 4, pp. 347-359, 2018