Chest
Clinical InvestigationsPeripheral Vascular Tone in Sepsis
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METHODS
The study population consisted of 23 patients who met the study entrance criteria for sepsis; there were ten control subjects. Sepsis was identified in patients by either a positive blood culture or an identifiable site of infection in the lungs, abdomen, or urinary tract. Patients were included in the study who had at least three of the following manifestations of sepsis: (1) hyperthermia (temperature >38.9°C) or hypothermia (temperature <35.5°C); (2) tachypnea (respiratory rate >20
RESULTS
Twenty-two patients were studied whose ages ranged between 42 and 84 years (median, 72 years). The ages of the control patients ranged from 46 to 81 years (median, 67 years). Mortality was 27 percent in the septic patients.
Forearm hemodynamic profiles are shown in Table 1. Sepsis prior to clinical evidence of perfusion failure was associated with increases in venous tone, decreases in FBF, and attenuation of RH. These changes were even more pronounced in patients with septic shock. Venous
DISCUSSION
In this study of peripheral vascular measurements in patients with sepsis and septic shock, we observed evidence of increased peripheral venous tone, modest increases in forearm resistance, and attenuation of the FBF response to RH. These changes appeared to be proportional to the severity of the clinical sepsis and were most pronounced in patients with septic shock where the influence of hypovolemia and systemic hypoperfusion were the most prominent. Indeed, similar observations have been made
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Manuscript received March 20; revision accepted October 2.