J D Young1, E M Cameron. 1. Department of Anesthesia and Critical Care, Harvard Medical School, Beth Israel Hospital, Boston, MA 02215, USA.
Abstract
OBJECTIVE: The study was undertaken to determine if sepsis alters the pattern of vasomotion and reactive hyperaemia in the skin. DESIGN: This was a prospective, observational study. SETTING: The study was performed in the medical and surgical intensive care units of a tertiary referral hospital. PATIENTS AND PARTICIPANTS: 11 patients with sepsis (using Bone's criteria [1]), were compared with 19 patients recovering from coronary artery bypass grafting who were used as non-septic controls. Nineteen normal volunteers were also studied. MEASUREMENTS AND RESULTS: Skin blood flow was measured on the forearm using laser Doppler flowmetry at rest and after 2 min arterial occlusion with a tourniquet. The resting blood signal was analyzed by calculating the mean skin blood flow, the power of the skin blood flow signal (variance) and the power spectrum. The rate of recovery after arterial occlusion was determined by calculating the peak increase in skin blood flow and the time constant of the decay of skin hyperaemia back to baseline flow. Patients with sepsis had a mean skin blood flow of 6.24 (3.48) ml min-1 per 100 g tissue compared with 4.35 (1.41) ml min-1 per 100 g tissue for the patients after coronary artery bypass grafting (p < 0.05). The septic patients also showed a marked increase in the fraction of total power in the 0.1-0.15 Hz frequency band (0.19 (0.17) versus 0.068 (0.033), p < 0.05), a decreased peak hyperaemic response (40 (23)% increase in flow above baseline after cuff release versus 147 (19)%) and a prolonged time constant for recovery from hyperaemia (22.8 (12.7) versus 11.7 (8.5) seconds, p < 0.05). These results imply an increased local rather than central control of skin blood flow. CONCLUSION: The laser Doppler flowmeter allows local rather than global haemodynamics to be studied. Abnormalities of skin blood flow control are found in sepsis, and this technique may prove useful to monitor the effects of treatment, especially if the use of laser Doppler flowmetry can be extended to other organs at risk of damage during sepsis such as gastro-intestinal mucosa.
OBJECTIVE: The study was undertaken to determine if sepsis alters the pattern of vasomotion and reactive hyperaemia in the skin. DESIGN: This was a prospective, observational study. SETTING: The study was performed in the medical and surgical intensive care units of a tertiary referral hospital. PATIENTS AND PARTICIPANTS: 11 patients with sepsis (using Bone's criteria [1]), were compared with 19 patients recovering from coronary artery bypass grafting who were used as non-septic controls. Nineteen normal volunteers were also studied. MEASUREMENTS AND RESULTS: Skin blood flow was measured on the forearm using laser Doppler flowmetry at rest and after 2 min arterial occlusion with a tourniquet. The resting blood signal was analyzed by calculating the mean skin blood flow, the power of the skin blood flow signal (variance) and the power spectrum. The rate of recovery after arterial occlusion was determined by calculating the peak increase in skin blood flow and the time constant of the decay of skin hyperaemia back to baseline flow. Patients with sepsis had a mean skin blood flow of 6.24 (3.48) ml min-1 per 100 g tissue compared with 4.35 (1.41) ml min-1 per 100 g tissue for the patients after coronary artery bypass grafting (p < 0.05). The septic patients also showed a marked increase in the fraction of total power in the 0.1-0.15 Hz frequency band (0.19 (0.17) versus 0.068 (0.033), p < 0.05), a decreased peak hyperaemic response (40 (23)% increase in flow above baseline after cuff release versus 147 (19)%) and a prolonged time constant for recovery from hyperaemia (22.8 (12.7) versus 11.7 (8.5) seconds, p < 0.05). These results imply an increased local rather than central control of skin blood flow. CONCLUSION: The laser Doppler flowmeter allows local rather than global haemodynamics to be studied. Abnormalities of skin blood flow control are found in sepsis, and this technique may prove useful to monitor the effects of treatment, especially if the use of laser Doppler flowmetry can be extended to other organs at risk of damage during sepsis such as gastro-intestinal mucosa.
Authors: Simon Skibsted; Ryan Arnold; Robert Sherwin; Sam Singh; David Lundy; Teresa Nelson; Michael Alexander Puskarich; Stephen Trzeciak; Alan Edward Jones; Nathan Ivan Shapiro Journal: Intern Emerg Med Date: 2013-07-04 Impact factor: 3.397
Authors: Paul M Middleton; Collin H H Tang; Gregory S H Chan; Sarah Bishop; Andrey V Savkin; Nigel H Lovell Journal: Med Biol Eng Comput Date: 2010-12-14 Impact factor: 2.602
Authors: Jacques Creteur; Tiziana Carollo; Giulia Soldati; Gustavo Buchele; Daniel De Backer; Jean-Louis Vincent Journal: Intensive Care Med Date: 2007-06-16 Impact factor: 17.440
Authors: Orren Wexler; Mary A M Morgan; Michael S Gough; Sherry D Steinmetz; Cynthia M Mack; Denise C Darling; Kathleen P Doolin; Michael J Apostolakos; Brian T Graves; Mark W Frampton; Xucai Chen; Anthony P Pietropaoli Journal: Crit Care Date: 2012-12-12 Impact factor: 9.097
Authors: Joshua S Davis; Tsin W Yeo; Jane H Thomas; Mark McMillan; Christabelle J Darcy; Yvette R McNeil; Allen C Cheng; David S Celermajer; Dianne P Stephens; Nicholas M Anstey Journal: Crit Care Date: 2009-09-25 Impact factor: 9.097
Authors: Günter Luckner; Martin W Dünser; Karl-Heinz Stadlbauer; Viktoria D Mayr; Stefan Jochberger; Volker Wenzel; Hanno Ulmer; Werner Pajk; Walter R Hasibeder; Barbara Friesenecker; Hans Knotzer Journal: Crit Care Date: 2006 Impact factor: 9.097