Microcirculatory Alterations in Traumatic Hemorrhagic Shock
Identifieur interne : 004060 ( Main/Exploration ); précédent : 004059; suivant : 004061Microcirculatory Alterations in Traumatic Hemorrhagic Shock
Auteurs : Guillaume Tachon [France] ; Anatole Harrois [France] ; Sebastien Tanaka [France] ; Hiromi Kato [France] ; Olivier Huet [France, Australie] ; Julien Pottecher [France] ; Eric Vicaut [France] ; Jacques Duranteau [France]Source :
- Critical care medicine [ 0090-3493 ] ; 2014.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Traumatisme.
English descriptors
- KwdEn :
Abstract
Objectives: Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma. Design: Prospective observational study. Setting: ICU. Patients: Eighteen traumatic hemorrhagic shock patients. Interventions: The sublingual microcirculation was estimated at the study inclusion after surgical or angiographic embolization to control bleeding (D1), and then three times at 24-hour intervals (D2, D3, and D4). Measurements and Main Results: Sublingual microcirculation was impaired for 72 hours despite restoration of the macrovascular circulation after control of bleeding in traumatic hemorrhagic shock patients. Furthermore, we found significantly higher decreases in the microvascular flow index and proportion of perfused vessels in high Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score ≥ 6) compared to low Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score < 6) without any differences in global hemodynamics between these two groups. Finally, the initial proportion of perfused vessels at D1 appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Conclusions: Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.
Affiliations:
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Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë, Equipe Universitaire 3509, Paris VII-Paris XI-Paris XIII</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno 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wicri:level="1"><inist:fA14 i1="01"><s1>AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation></author><author><name sortKey="Harrois, Anatole" sort="Harrois, Anatole" uniqKey="Harrois A" first="Anatole" last="Harrois">Anatole Harrois</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë, Equipe Universitaire 3509, Paris VII-Paris XI-Paris XIII</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Tanaka, Sebastien" sort="Tanaka, Sebastien" uniqKey="Tanaka S" first="Sebastien" last="Tanaka">Sebastien Tanaka</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation></author><author><name sortKey="Kato, Hiromi" sort="Kato, Hiromi" uniqKey="Kato H" first="Hiromi" last="Kato">Hiromi Kato</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë, Equipe Universitaire 3509, Paris VII-Paris XI-Paris XIII</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Huet, Olivier" sort="Huet, Olivier" uniqKey="Huet O" first="Olivier" last="Huet">Olivier Huet</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Baker IDI Heart and Diabetes Institute</s1><s2>Melbourne, VIC</s2><s3>AUS</s3><sZ>5 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Baker IDI Heart and Diabetes Institute</wicri:noRegion></affiliation></author><author><name sortKey="Pottecher, Julien" sort="Pottecher, Julien" uniqKey="Pottecher J" first="Julien" last="Pottecher">Julien Pottecher</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Hôpitaux Universitaires de Strasbourg, Service d'Anesthésie-Réanimation Chirurgicale, Hôpital de Hautepierre, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Equipe d'accueil EA 3072 "Mitochondrie, stress oxydant et protection musculaire" Strasbourg</s1><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>stress oxydant et protection musculaire" Strasbourg</wicri:noRegion><wicri:noRegion>Hôpitaux Universitaires de Strasbourg, Service d'Anesthésie-Réanimation Chirurgicale, Hôpital de Hautepierre, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Equipe d'accueil EA 3072 "Mitochondrie, stress oxydant et protection musculaire" Strasbourg</wicri:noRegion></affiliation></author><author><name sortKey="Vicaut, Eric" sort="Vicaut, Eric" uniqKey="Vicaut E" first="Eric" last="Vicaut">Eric Vicaut</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë, Equipe Universitaire 3509, Paris VII-Paris XI-Paris XIII</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Duranteau, Jacques" sort="Duranteau, Jacques" uniqKey="Duranteau J" first="Jacques" last="Duranteau">Jacques Duranteau</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre</s1><s2>Le Kremlin-Bicêtre</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion><wicri:noRegion>Hôpital de Bicêtre</wicri:noRegion><wicri:noRegion>Le Kremlin-Bicêtre</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë, Equipe Universitaire 3509, Paris VII-Paris XI-Paris XIII</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Critical care medicine</title><title level="j" type="abbreviated">Crit. care med.</title><idno type="ISSN">0090-3493</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Critical care medicine</title><title level="j" type="abbreviated">Crit. care med.</title><idno type="ISSN">0090-3493</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Dysfunction</term><term>Hemorrhage</term><term>Intensive care</term><term>Microcirculation</term><term>Organ</term><term>Resuscitation</term><term>Shock</term><term>Sublingual</term><term>Trauma</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Traumatisme</term><term>Hémorragie</term><term>Choc</term><term>Organe</term><term>Trouble fonctionnel</term><term>Sublingual</term><term>Microcirculation</term><term>Réanimation</term><term>Soin intensif</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Traumatisme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives: Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma. Design: Prospective observational study. Setting: ICU. Patients: Eighteen traumatic hemorrhagic shock patients. Interventions: The sublingual microcirculation was estimated at the study inclusion after surgical or angiographic embolization to control bleeding (D1), and then three times at 24-hour intervals (D2, D3, and D4). Measurements and Main Results: Sublingual microcirculation was impaired for 72 hours despite restoration of the macrovascular circulation after control of bleeding in traumatic hemorrhagic shock patients. Furthermore, we found significantly higher decreases in the microvascular flow index and proportion of perfused vessels in high Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score ≥ 6) compared to low Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score < 6) without any differences in global hemodynamics between these two groups. Finally, the initial proportion of perfused vessels at D1 appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Conclusions: Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li></country><region><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Tachon, Guillaume" sort="Tachon, Guillaume" uniqKey="Tachon G" first="Guillaume" last="Tachon">Guillaume Tachon</name></noRegion><name sortKey="Duranteau, Jacques" sort="Duranteau, Jacques" uniqKey="Duranteau J" first="Jacques" last="Duranteau">Jacques Duranteau</name><name sortKey="Duranteau, Jacques" sort="Duranteau, Jacques" uniqKey="Duranteau J" first="Jacques" last="Duranteau">Jacques Duranteau</name><name sortKey="Harrois, Anatole" sort="Harrois, Anatole" uniqKey="Harrois A" first="Anatole" last="Harrois">Anatole Harrois</name><name sortKey="Harrois, Anatole" sort="Harrois, Anatole" uniqKey="Harrois A" first="Anatole" last="Harrois">Anatole Harrois</name><name sortKey="Huet, Olivier" sort="Huet, Olivier" uniqKey="Huet O" first="Olivier" last="Huet">Olivier Huet</name><name sortKey="Kato, Hiromi" sort="Kato, Hiromi" uniqKey="Kato H" first="Hiromi" last="Kato">Hiromi Kato</name><name sortKey="Pottecher, Julien" sort="Pottecher, Julien" uniqKey="Pottecher J" first="Julien" last="Pottecher">Julien Pottecher</name><name sortKey="Tanaka, Sebastien" sort="Tanaka, Sebastien" uniqKey="Tanaka S" first="Sebastien" last="Tanaka">Sebastien Tanaka</name><name sortKey="Vicaut, Eric" sort="Vicaut, Eric" uniqKey="Vicaut E" first="Eric" last="Vicaut">Eric Vicaut</name></country><country name="Australie"><noRegion><name sortKey="Huet, Olivier" sort="Huet, Olivier" uniqKey="Huet O" first="Olivier" last="Huet">Olivier Huet</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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