Chest
Volume 99, Issue 5, May 1991, Pages 1072-1075
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Clinical Investigations
Peripheral Vascular Tone in Sepsis

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Septic shock is characterized as a distributive form of circulatory failure. We examined the relationship of changes in forearm arterial, venous, and microvascular tone to the severity of sepsis. The study population consisted of ten control patients, 15 patients with sepsis, and eight patients with sepsis and shock. Patients treated with inotropic, vasopressor, or vasodilator drugs were excluded from the study. Forearm venous capacity (MVC), forearm venous tone (F-VT), arterial blood flow (FBF), forearm arterial resistance (FAR), and hyperemic response (FBF-RH) were measured using air plethysmography. MVC was decreased and VT increased in septic and septic shock patients. FBF was decreased with modest increases in FAR in septic and septic shock patients. FBF-RH was significantly reduced in both septic and septic shock patients. Decreases in FVT and attenuation of the reactive response to hyperemia occurred early in sepsis in patients without clinical evidence of hypoperfusion. In our patients, progressive vasodilatation in skeletal muscle was not associated with severe sepsis. These changes appear to be proportional to the severity of sepsis and are most pronounced in patients with circulatory failure. (Chest 1991; 99:1072-75)

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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.

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