Marked regional endothelial dysfunction in mottled skin area in patients with severe infectionsReportar como inadecuado

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* Corresponding author 1 iPLESP - Institut Pierre Louis d-Epidémiologie et de Santé Publique 2 Service de Réanimation Médicale CHU Saint-Antoine 3 UPMC - Université Pierre et Marie Curie - Paris 6 4 PARCC - Paris-Centre de Recherche Cardiovasculaire 5 Department of Anesthesiology and Critical Care Medicine Québec, QC, Canada

Abstract : AbstractBackgroundMottling around the knee, reflecting a reduced skin blood flow, is predictive of mortality in patients with septic shock. However, the causative pathophysiology of mottling remains unknown. We hypothesized that the cutaneous hypoperfusion observed in the mottled area is related to regional endothelial dysfunction.MethodsThis was a prospective, observational study in a medical ICU in a tertiary teaching hospital. Consecutive adult patients with sepsis admitted to ICU were included. After resuscitation, endothelium-dependent vasodilation in the skin circulation was measured before and after iontophoresis of acetylcholine Ach in the forearm and the knee area. We analyzed the patterns of induced vasodilatation according to the presence or absence of mottling and vital status at 14 days.ResultsWe evaluated 37 septic patients, including 11 without and 26 with septic shock. Overall 14-day mortality was 22%. Ten patients had mottling around the knee 10-37, 27%. In the knee area, the increased skin blood flow following iontophoresis of Ach was lower in patients with mottled skin as compared to patients without mottled skin area under curve AUC 3280 2643–6440 vs. 7980 4233–19,707, both P 

Autor: Simon Bourcier - Jérémie Joffre - Vincent Dubée - Gabriel Preda - Jean-Luc Baudel - Naïke Bigé - Guillaume Leblanc - Bernard



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