Department of Clinical Skills and Medical Technology, Rīga Stradiņš University, LV-1007 Riga, Latvia.
Department of Anaesthesiology and Reanimatology, Rīga Stradiņš University, LV-1007 Riga, Latvia.
Medicina (Kaunas). 2024 Oct 14;60(10):1680. doi: 10.3390/medicina60101680.
Sepsis, a leading global health challenge, accounts for around 20% of deaths worldwide. The complexity of sepsis, especially the difference between bacterial and viral etiologies, requires an effective assessment of microcirculation during resuscitation. This study aimed to evaluate the impact of infusion therapy on microcirculation in patients with sepsis, focusing on bacterial- and COVID-19-associated sepsis using remote photoplethysmography (rPPG) and the automated capillary refill time (aCRT). This single-center prospective study was conducted in the ICU of Pauls Stradins Clinical University Hospital, including 20 patients with sepsis/septic shock. The patients were selected based on hemodynamic instability and divided into COVID-19 and Bacterial Septic Shock groups. Fluid responsiveness was assessed using the Passive Leg Raising Test (PLRT). Systemic hemodynamics and microcirculation were monitored through MAP CRT, rPPG, and serum lactate levels. Statistical analyses compared responses within and between the groups across different stages of the protocol. The Bacterial group exhibited higher initial serum lactate levels and more pronounced microcirculatory dysfunction than the COVID-19 group. rPPG was more sensitive in detecting perfusion changes, showing significant differences between the groups. The automated CRT demonstrated greater sensitivity compared to the manual CRT, revealing significant differences during PLRT stages between bacterial- and COVID-19-associated sepsis. Both groups had a transient hemodynamic response to PLRT, with subsequent stabilization upon fluid infusion. When managing patients with sepsis in intensive care, monitoring microcirculation is of paramount importance in infusion therapy. Our study highlights the potential of rPPG and aCRT as tools for this purpose. These techniques can be used in conjunction with routine parameters, such as lactate levels and systemic hemodynamic parameters, to provide a comprehensive assessment of a patient's condition.
脓毒症是一个主要的全球健康挑战，占全球死亡人数的 20%左右。脓毒症的复杂性，特别是细菌和病毒病因之间的差异，需要在复苏过程中对微循环进行有效的评估。本研究旨在评估输注治疗对脓毒症患者微循环的影响，重点关注细菌和 COVID-19 相关脓毒症，使用远程光体积描记法(rPPG)和自动毛细血管再充盈时间(aCRT)。这项单中心前瞻性研究在保拉斯·斯特拉津斯临床大学医院的 ICU 进行，包括 20 名脓毒症/脓毒性休克患者。根据血流动力学不稳定选择患者，并将其分为 COVID-19 和细菌性休克组。使用被动抬腿试验(PLRT)评估液体反应性。通过 MAP CRT、rPPG 和血清乳酸水平监测系统血流动力学和微循环。统计分析比较了不同阶段协议内和组间的反应。与 COVID-19 组相比，细菌性组初始血清乳酸水平更高，微循环功能障碍更明显。rPPG 在检测灌注变化方面更敏感，两组间存在显著差异。与手动 CRT 相比，自动 CRT 具有更高的敏感性，在细菌和 COVID-19 相关脓毒症的 PLRT 阶段之间显示出显著差异。两组在 PLRT 后均出现短暂的血流动力学反应，随后在液体输注后稳定下来。在重症监护中管理脓毒症患者时，监测微循环在输液治疗中至关重要。我们的研究强调了 rPPG 和 aCRT 作为该目的工具的潜力。这些技术可以与乳酸水平和系统血流动力学参数等常规参数结合使用，对患者的病情进行全面评估。
