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Effects of Fluids on the Sublingual Microcirculation in Sepsis

Sepsis is one of the most common and deadly syndromes faced in Intensive Care settings globally. Recent advances in bedside imaging have defined the changes in the microcirculation in sepsis. One of the most advocated interventions for sepsis is fluid therapy. Whether or not fluid bolus affects the...

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Autores principales: Cusack, Rachael, O’Neill, Susan, Martin-Loeches, Ignacio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9786137/
https://www.ncbi.nlm.nih.gov/pubmed/36555895
http://dx.doi.org/10.3390/jcm11247277
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author Cusack, Rachael
O’Neill, Susan
Martin-Loeches, Ignacio
author_facet Cusack, Rachael
O’Neill, Susan
Martin-Loeches, Ignacio
author_sort Cusack, Rachael
collection PubMed
description Sepsis is one of the most common and deadly syndromes faced in Intensive Care settings globally. Recent advances in bedside imaging have defined the changes in the microcirculation in sepsis. One of the most advocated interventions for sepsis is fluid therapy. Whether or not fluid bolus affects the microcirculation in sepsis has not been fully addressed in the literature. This systematic review of the evidence aims to collate studies examining the microcirculatory outcomes after a fluid bolus in patients with sepsis. We will assimilate the evidence for using handheld intra vital microscopes to guide fluid resuscitation and the effect of fluid bolus on the sublingual microcirculation in patients with sepsis and septic shock. We conducted a systematic search of Embase, CENTRAL and Medline (PubMed) using combinations of the terms “microcirculation” AND “fluid” OR “fluid resuscitation” OR “fluid bolus” AND “sepsis” OR “septic shock”. We found 3376 potentially relevant studies. Fifteen studies published between 2007 and 2021 fulfilled eligibility criteria to be included in analysis. The total number of participants was 813; we included six randomized controlled trials and nine non-randomized, prospective observational studies. Ninety percent used Sidestream Dark Field microscopy to examine the microcirculation and 50% used Hydroxyethyl Starch as their resuscitation fluid. There were no clear effects of fluid on the microcirculation parameters. There was too much heterogeneity between studies and methodology to perform meta-analysis. Studies identified heterogeneity of affect in the sepsis population, which could mean that current clinical classifications were not able to identify different microcirculation characteristics. Use of microcirculation as a clinical endpoint in sepsis could help to define sepsis phenotypes. More research into the effects of different resuscitation fluids on the microcirculation is needed.
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spelling pubmed-97861372022-12-24 Effects of Fluids on the Sublingual Microcirculation in Sepsis Cusack, Rachael O’Neill, Susan Martin-Loeches, Ignacio J Clin Med Systematic Review Sepsis is one of the most common and deadly syndromes faced in Intensive Care settings globally. Recent advances in bedside imaging have defined the changes in the microcirculation in sepsis. One of the most advocated interventions for sepsis is fluid therapy. Whether or not fluid bolus affects the microcirculation in sepsis has not been fully addressed in the literature. This systematic review of the evidence aims to collate studies examining the microcirculatory outcomes after a fluid bolus in patients with sepsis. We will assimilate the evidence for using handheld intra vital microscopes to guide fluid resuscitation and the effect of fluid bolus on the sublingual microcirculation in patients with sepsis and septic shock. We conducted a systematic search of Embase, CENTRAL and Medline (PubMed) using combinations of the terms “microcirculation” AND “fluid” OR “fluid resuscitation” OR “fluid bolus” AND “sepsis” OR “septic shock”. We found 3376 potentially relevant studies. Fifteen studies published between 2007 and 2021 fulfilled eligibility criteria to be included in analysis. The total number of participants was 813; we included six randomized controlled trials and nine non-randomized, prospective observational studies. Ninety percent used Sidestream Dark Field microscopy to examine the microcirculation and 50% used Hydroxyethyl Starch as their resuscitation fluid. There were no clear effects of fluid on the microcirculation parameters. There was too much heterogeneity between studies and methodology to perform meta-analysis. Studies identified heterogeneity of affect in the sepsis population, which could mean that current clinical classifications were not able to identify different microcirculation characteristics. Use of microcirculation as a clinical endpoint in sepsis could help to define sepsis phenotypes. More research into the effects of different resuscitation fluids on the microcirculation is needed. MDPI 2022-12-08 /pmc/articles/PMC9786137/ /pubmed/36555895 http://dx.doi.org/10.3390/jcm11247277 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Cusack, Rachael
O’Neill, Susan
Martin-Loeches, Ignacio
Effects of Fluids on the Sublingual Microcirculation in Sepsis
title Effects of Fluids on the Sublingual Microcirculation in Sepsis
title_full Effects of Fluids on the Sublingual Microcirculation in Sepsis
title_fullStr Effects of Fluids on the Sublingual Microcirculation in Sepsis
title_full_unstemmed Effects of Fluids on the Sublingual Microcirculation in Sepsis
title_short Effects of Fluids on the Sublingual Microcirculation in Sepsis
title_sort effects of fluids on the sublingual microcirculation in sepsis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9786137/
https://www.ncbi.nlm.nih.gov/pubmed/36555895
http://dx.doi.org/10.3390/jcm11247277
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