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Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients

Abstract

Purpose

To assess sublingual microcirculatory changes following passive leg raising (PLR) and volume expansion (VE) in septic patients.

Methods

This prospective study was conducted in two university hospital intensive care units and included 25 mechanically ventilated patients with severe sepsis or septic shock who were eligible for VE in the first 24 h of their admission. Pulse pressure variation (ΔPP), cardiac output (CO) and sublingual microcirculation indices were assessed at five consecutive steps: (1) semi-recumbent position (Baseline 1), (2) during PLR manoeuvre (PLR), (3) after returning to semi-recumbent position (Baseline 2), (4) at the time when VE induced the same degree of preload responsiveness as PLR (VE∆PP = PLR) and (5) at the end of VE (VEEND). At each step, five sublingual microcirculation sequences were acquired using sidestream darkfield imaging to assess functional capillary density (FCD), microcirculatory flow index (MFI), proportion of perfused vessels (PPV) and flow heterogeneity index (FHI).

Results

The PLR, VE∆PP = PLR and VEEND induced a significant increase in CO and a significant decrease in ΔPP compared to Baseline 1 and Baseline 2 values. Both PLR and VE induced significant increases in FCD, MFI and PPV and a significant decrease in FHI compared to Baseline 1 and Baseline 2 values.

Conclusions

In preload responsive severe septic patients examined within the first 24 h of their admission, both PLR and VE improved sublingual microcirculatory perfusion. At the level of volume infusion used in this study, these changes in sublingual microcirculation were not explained by changes in rheologic factors or changes in arterial pressure.

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Acknowledgments

We are greatly indebted to Mr Nicolas Sandri, computer engineer, for his extensive software knowledge and invaluable technical assistance. Financial supports used for the study only included institutional departmental funds.

Author information

Correspondence to Jacques Duranteau.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-010-1973-7.

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Pottecher, J., Deruddre, S., Teboul, J. et al. Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med 36, 1867–1874 (2010) doi:10.1007/s00134-010-1966-6

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Keywords

  • Microcirculation
  • Sepsis
  • Shock
  • Volume expansion
  • Fluid responsiveness
  • Passive leg raising