Abstract
Objective
The study was undertaken to determine if sepsis alters the pattern of vasomotion and reactive hyperaemia in the skin.
Design
This was a prospective, observational study.Setting: The study was performed in the medical and surgical intensive care units of a tertiary referral hospital.
Patients and participants
11 patients with sepsis (using Bone's criteria [1]), were compared with 19 patients recovering from coronary artery bypass grafting who were used as non-septic controls. Nineteen normal volunteers were also studied.
Measurements and results
Skin blood flow was measured on the forearm using laser Doppler flowmetry at rest and after 2 min arterial occlusion with a tourniquet. The resting blood signal was analyzed by calculating the mean skin blood flow, the power of the skin blood flow signal (variance) and the power spectrum. The rate of recovery after arterial occlusion was determined by calculating the peak increase in skin blood flow and the time constant of the decay of skin hyperaemia back to baseline flow. Patients with sepsis had a mean skin blood flow of 6.24 (3.48) ml min−1 per 100 g tissue compared with 4.35 (1.41) ml min−1 per 100 g tissue for the patients after coronary artery bypass grafting (p<0.05). The septic patients also showed a marked increase in the fraction of total power in the 0.1–0.15 Hz frequency band (0.19 (0.17) versus 0.068 (0.033),p<0.05), a decreased peak hyperaemic response (40 (23)% increase in flow above baseline after cuff release versus 147 (19)% and a prolonged time constant for recovery from hyperaemia (22.8 (12.7) versus 11.7 (8.5) seconds,p<0.05). These results imply an increased local rather than central control of skin blood flow.
Conclusion
The laser Doppler flowmeter allows local rather than global haemodynamics to be studied. Abnormalities of skin blood flow control are found in sepsis, and this technique may prove useful to monitor the effects of treatment, especially if the use of laser Doppler flowmetry can be extended to other organs at risk of damage during sepsis such as gastro-intestinal mucosa.
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References
Bone RC (1991) Let's agree on terminology: definitions of sepsis. Crit Care Med 19:973–976
Parker MM, Shelhamer JH, Natason C, Alling DW, Parillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929
Edwards JD, Brown CS, Nightingale P, Slater RM, Faragher EB (1989) Use of survivor's cardiorespiratory values as therapeutic goals in septic shock. Crit Care Med 17:1098–1103
Edwards JD (1991) Oxygen transport in cardiogenic and septic shock. Crit Care Med 19:658–663
Tuchschnidt J, Oblitas D, Fried JC (1991) Oxygen consumption in sepsis and septic shock. Crit Care Med 19: 664–671
Mackenzie SJ, Kapadia F, Nimmo GR, Armstrong IR, Grant IS (1991) Adrenaline in treatment of septic shock: effects on haemodynamics and oxygen transport. Intensive Care Med 17:36–39
Abraham E, Shoemaker WC, Bland RD, Cobo JC (1983) Sequential cardiorespiratory patterns in septic shock. Crit Care Med 11:799–803
Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 134:873–878
Sakaguchi M, Hosie KB, Gourevitch D, Tudor R, Hioki K, Yamamoto M, Young HL, Keighley MRB (1990) Laser Doppler assessment of human colonic blood flow. J Med Eng Tech 14: 188–189
Allen PIM, Gourevitch D, Goldman M (1987) Non-invasive endoscopic technique to assess gastrointestinal perfusion. Br J Surg 74:1053–1055
Engelhart M, Kristensen JK (1983) Evaluation of cutaneous blood flow responses by xenon-133 washout and laser-Doppler flowmeter. J Invest Dermatol 80:12–15
Holloway GA, Watkins DW (1977) Laser-Doppler measurement of cutaneous blood flow. J Invest Dermatol 69: 306–309
Neufeld GR, Galante SR, Whang JM, DeVries D, Baumgardner JE, Graves DJ, Quinn JA (1988) Skin blood flow from gas transport: helium xenon and laser Doppler compared. Microvasc Res 35:143–152
Tamura T, Togawa T, Yokoyama K (1992) Comparison of laser Doppler fluxmetry and the thermal diffusion method of measuring skin blood flow with hydrogen clearance. Int J Microcirc Clin Exp 11:97–107
Kvietys PR, Shepherd AP, Granger DN (1985) Laser-Doppler H2 clearance and microsphere estimates of laser blood flow. Am J Physiol 249:G211–227
Obeid AN, Barnett NJ, Dougherty G, Ward G (1990) A critical review of laser Doppler flowmetry. J Med Eng Tech 14:178–181
Tenland T, Salerud EG, Nilsson GE, Oberg PA (1983) Spatial and temporal variations in skin blood flow. Int J Microcirc Clin Exp 2:81–90
Lantsberg L, Goldman M (1990) Lower limb sympathectomy assessed by laser Doppler blood flow and transcutaneous oxygen measurements. J Med Eng Tech 14:182–183
Barker SJ, Hyatt J, Clarke C, Tremper KK (1991) Hyperventilation reduces transcutaneous oxygen tension and skin blood flow. Anesthesiology 75: 619–624
Caspary L, Creutzig A, Alexander K (1987) Comparison of laser-Doppler-flux and tcPO2 in healthy probands and patients with arterial ischemia. Adv Exp Med Biol 220:235–240
Ewald U, Huch A, Huch R, Rooth G (1987) Skin reactive hyperemia recorded by a combined tcPO2 and laser Doppler sensor. Adv Exp Med Biol 220: 231–234
Kastrup J, Bulow J, Lassen NA (1989) Vasomotion in human skin before and after local heating recorded with laser Doppler flowmetry. A method for induction of vasomotion. Int J Microcirc Clin Exp 8:205–215
Smits TM, Aarnoudse JG, Geerdink JJ, Zijlstra WG (1987) Hyperventilationinduced changes in periodic oscillations in forehead skin flow measured by laser Doppler flowmetry. Int J Microcirc Clin Exp 6:149–159
Fagrell B, Intaglietta M, Oestergren J (1980) Relative hematocrit in human skin capillaries and its relation to capillary flow velocity. Microvasc Res 20: 327–335
Bernardi L, Rossi M, Fratino P, Finardi G, Mevio E, Orlandi C (1989) Relationship between phasic changes in human skin blood flow and autonomic tone. Microvasc Res 37:16–27
Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, Sandrone G, Malfatto G, Dell'Orto S, Piccaluga E, Turiel M, Baselli G (1986) Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 59:178–193
Penaz J (1978) Mayer waves: history and methodology. Automedica 2: 135–141
Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ (1985) Hemodynamic regulation: investigation by spectral analysis. Am J Physiol 249:H867–875
Burch GE, De Pasquale N (1960) Relation of arterial pressure to spontaneous variations in digital volume. J Appl Physiol 15:23–24
Salerud EG, Tenland T, Nilsson GE, Oberg PA (1983) Rhythmical variations in human skin blood flow. Int J Microcirc Clin Exp 2:91–102
Colantuoni A, Bertuglia S, Intaglietta M (1984) Quantitation of rhythmic diameter changes in arterial microcirculation. Am J Physiol 246:H508-H517
Funk W, Endrich B, Messmer K, Intaglitta M (1983) Spontaneous arteriolar vasomotion as a determinant of peripheral vascular resistance. Int J Microcirc Clin Exp 2:11–25
Bouskela E, Grampp W (1992) Spontaneous vasomotion in hamster cheek pouch arterioles in varying experimental conditions. Am J Physiol 31: H478-H485
Kano T, Shimoda O, Hashiguchi A, Satoh T (1991) Periodic abnormal fluctuations of blood pressure, heart rate and skin blood flow appearing in a resuscitated comatose patient. J Auton Nerv Syst 36:115–122
Irazuzta JE, Berde CB, Sethna NF (1992) Laser Doppler measurements of skin blood flow before, during, and after lubar sympathetic blockade in children and young adults with reflex sympathetic dystrophy syndrome. J Clin Monit 8:16–19
Kimura T, Kemmotsu O, Shimada Y (1992) Regional differences in skin blood flow and temperature during total spinal anaesthesia. Can J Anaesth 39:123–127
Low PA, Neumann C, Dyck PJ, Fealey RD, Tuck RR (1983) Evaluation of skin vasomotor reflexes using laser Doppler velocimetry. Mayo Clin Proc 58: 583–592
Kitney RI (1957) An analysis of the non-linear behavior of the human thermal control system. J Theor Biol 52: 231–248
Khan F, Spence VA, Wilson SB, Abbott NC (1991) Quantification of sympathetic vascular responses in skin by laser Doppler flowmetry. Int J Microcirc Clin Exp 10:145–153
Haisjakl M, Hasibeder W, Klaunzer S, Altenberger H, Koller W (1990) Dlminished reactive hyperemia in the skin of critically ill patients. Crit Care Med 18:813–818
Kostic MM, Schrader J (1992) Role of nitric oxide in reactive hyperemia of the guinea pig heart. Circ Res 70:208–212
Larkin SW, Williams TJ (1993) Evidence for sensory nerve involvement in cutaneous reactive hyperaemia in humans Circ Res 73:147–154
Koller A, Kaley G (1990) Role of endothelium in reactive dilatation of skeletal muscle arterioles. Am J Physiol 259: H1313-H1316
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Young, J.D., Cameron, E.M. Dynamics of skin blood flow in human sepsis. Intensive Care Med 21, 669–674 (1995). https://doi.org/10.1007/BF01711546
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DOI: https://doi.org/10.1007/BF01711546