Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis.

Autor: Nobre V; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil.; Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Ataíde TB; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Brant LC; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Oliveira CR; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Rodrigues LV; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Ribeiro AL; Programa de Pós-Graduação em Infectologia e Medicina Tropical, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil.; Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Lopes FB; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Saraiva IE; Serviço de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Andrade MV; Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil.
Jazyk: Portuguese; English
Zdroj: Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2016 Oct-Dec; Vol. 28 (4), pp. 387-396.
DOI: 10.5935/0103-507X.20160072
Abstrakt: Objective:: To evaluate the usefulness and prognostic value of reactive hyperemia - peripheral arterial tonometry in patients with sepsis. Moreover, we investigated the association of reactive hyperemia - peripheral arterial tonometry results with serum levels of certain inflammatory molecules.
Methods:: Prospective study, conducted in an 18-bed mixed intensive care unit for adults. The exclusion criteria included severe immunosuppression or antibiotic therapy initiated more than 48 hours before assessment. We measured the reactive hyperemia - peripheral arterial tonometry on inclusion (day 1) and on day 3. Interleukin-6, interleukin-10, high-mobility group box 1 protein and soluble ST2 levels were measured in the blood obtained upon inclusion.
Results:: Seventeen of the 79 patients (21.6%) enrolled were determined to have reactive hyperemia - peripheral arterial tonometry signals considered technically unreliable and were excluded from the study. Thus, 62 patients were included in the final analysis, and they underwent a total of 95 reactive hyperemia - peripheral arterial tonometry exams within the first 48 hours after inclusion. The mean age was 51.5 (SD: 18.9), and 49 (62%) of the patients were male. Reactive hyperemia indexes from days 1 and 3 were not associated with vasopressor need, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, or 28-day mortality. Among the patients who died, compared with survivors, there was a significant increase in the day 3 reactive hyperemia index compared with day 1 (p = 0.045). There was a weak negative correlation between the day 1 reactive hyperemia - peripheral arterial tonometry index and the levels of high-mobility group box 1 protein (r = -0.287).
Conclusion:: Technical difficulties and the lack of clear associations between the exam results and clinical severity or outcomes strongly limits the utility of reactive hyperemia - peripheral arterial tonometry in septic patients admitted to the intensive care unit.
Competing Interests: None.
Databáze: MEDLINE
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