Brachial artery reactivity in patients with severe sepsis: an observational study
| Autor: | Cynthia M. Mack, Michael J. Apostolakos, Denise C. Darling, Orren Wexler, Sherry Steinmetz, Mary Anne M. Morgan, Brian T. Graves, Mark W. Frampton, Kathleen P. Doolin, Michael S. Gough, Xucai Chen, Anthony P. Pietropaoli |
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| Jazyk: | angličtina |
| Předmět: |
Male
medicine.medical_specialty Brachial Artery Ischemia 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Sepsis 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine medicine.artery medicine Humans Prospective Studies Brachial artery Prospective cohort study Survival rate Reactive hyperemia Ultrasonography Chi-Square Distribution business.industry Research Reproducibility of Results 030208 emergency & critical care medicine Middle Aged medicine.disease 3. Good health Surgery Survival Rate Intensive Care Units medicine.anatomical_structure ROC Curve Area Under Curve Case-Control Studies Cardiology Female business Blood Flow Velocity Artery |
| Zdroj: | Critical Care |
| ISSN: | 1364-8535 |
| DOI: | 10.1186/cc11223 |
| Popis: | Introduction Ultrasound measurements of brachial artery reactivity in response to stagnant ischemia provide estimates of microvascular function and conduit artery endothelial function. We hypothesized that brachial artery reactivity would independently predict severe sepsis and severe sepsis mortality. Methods This was a combined case-control and prospective cohort study. We measured brachial artery reactivity in 95 severe sepsis patients admitted to the medical and surgical intensive care units of an academic medical center and in 52 control subjects without acute illness. Measurements were compared in severe sepsis patients versus control subjects and in severe sepsis survivors versus nonsurvivors. Multivariable analyses were also conducted. Results Hyperemic velocity (centimeters per cardiac cycle) and flow-mediated dilation (percentage) were significantly lower in severe sepsis patients versus control subjects (hyperemic velocity: severe sepsis = 34 (25 to 48) versus controls = 63 (52 to 81), P < 0.001; flow-mediated dilation: severe sepsis = 2.65 (0.81 to 4.79) versus controls = 4.11 (3.06 to 6.78), P < 0.001; values expressed as median (interquartile range)). Hyperemic velocity, but not flow-mediated dilation, was significantly lower in hospital nonsurvivors versus survivors (hyperemic velocity: nonsurvivors = 25 (16 to 28) versus survivors = 39 (30 to 50), P < 0.001; flow-mediated dilation: nonsurvivors = 1.90 (0.68 to 3.41) versus survivors = 2.96 (0.91 to 4.86), P = 0.12). Lower hyperemic velocity was independently associated with hospital mortality in multivariable analysis (odds ratio = 1.11 (95% confidence interval = 1.04 to 1.19) per 1 cm/cardiac cycle decrease in hyperemic velocity; P = 0.003). Conclusions Brachial artery hyperemic blood velocity is a noninvasive index of microvascular function that independently predicts mortality in severe sepsis. In contrast, brachial artery flow-mediated dilation, reflecting conduit artery endothelial function, was not associated with mortality in our severe sepsis cohort. Brachial artery hyperemic velocity may be a useful measurement to identify patients who could benefit from novel therapies designed to reverse microvascular dysfunction in severe sepsis and to assess the physiologic efficacy of these treatments. |
| Databáze: | OpenAIRE |
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