Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock
Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, p...
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2012-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/536852 |
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| author | Glenn Hernandez Alejandro Bruhn Ricardo Castro Cesar Pedreros Maximiliano Rovegno Eduardo Kattan Enrique Veas Andrea Fuentealba Tomas Regueira Carolina Ruiz Can Ince |
| author_facet | Glenn Hernandez Alejandro Bruhn Ricardo Castro Cesar Pedreros Maximiliano Rovegno Eduardo Kattan Enrique Veas Andrea Fuentealba Tomas Regueira Carolina Ruiz Can Ince |
| author_sort | Glenn Hernandez |
| collection | DOAJ |
| description | Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared.
Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile. |
| format | Article |
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| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-4d4173e7fdf34a66942121b90bc5a9b92025-02-03T06:01:22ZengWileyCritical Care Research and Practice2090-13052090-13132012-01-01201210.1155/2012/536852536852Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic ShockGlenn Hernandez0Alejandro Bruhn1Ricardo Castro2Cesar Pedreros3Maximiliano Rovegno4Eduardo Kattan5Enrique Veas6Andrea Fuentealba7Tomas Regueira8Carolina Ruiz9Can Ince10Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The NetherlandsDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, 8320000 Santiago, ChileDepartment of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The NetherlandsIntroduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.http://dx.doi.org/10.1155/2012/536852 |
| spellingShingle | Glenn Hernandez Alejandro Bruhn Ricardo Castro Cesar Pedreros Maximiliano Rovegno Eduardo Kattan Enrique Veas Andrea Fuentealba Tomas Regueira Carolina Ruiz Can Ince Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock Critical Care Research and Practice |
| title | Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock |
| title_full | Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock |
| title_fullStr | Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock |
| title_full_unstemmed | Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock |
| title_short | Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock |
| title_sort | persistent sepsis induced hypotension without hyperlactatemia a distinct clinical and physiological profile within the spectrum of septic shock |
| url | http://dx.doi.org/10.1155/2012/536852 |
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