Guimarães Lilian Barth, Guimarães César Maistro, Carraro Junior Hipólito, Assreuy Filho Jamil, de Menezes Igor Alexandre Côrtes
Intensive Care Unit, Hospital de Clínicas, Universidade Federal do Paraná - Curitiba (PR), Brazil.
Intensive Care Unit, Hospital e Maternidade São José dos Pinhais - São José dos Pinhais, (PR), Brazil.
Crit Care Sci. 2024 Dec 2;36:e20240090en. doi: 10.62675/2965-2774.20240090-en. eCollection 2024.
To evaluate whether the perfusion index response to semiorthostatic stress can be used to monitor the sympathetic-vascular response in sepsis patients.
Three groups were studied: Group A (30 healthy patients), Group B (30 critically ill patients without sepsis), and Group C (92 septic patients). The patients underwent a semiorthostatic stress test (head elevation from 0 to 60 degrees), and hemodynamics, perfusion index values and cardiac ultrasound data were evaluated. SOFA scores were also evaluated in septic patients, comparing those with increased and decreased perfusion indices after the test.
After the test, Group A presented significant reductions in stroke volume (p < 0.01) and the cardiac index (p < 0.05), with increases in heart rate (p < 0.05) and mean arterial pressure (p < 0.001). These responses were not observed in Groups B and C. In the individual analysis of Group A, there was a decrease in the perfusion index (p < 0,001), whereas in Groups B and C, the response was heterogeneous. Additionally, septic patients who had a reduced perfusion index after the test had a significant decrease in the SOFA score at 72 hours compared with the group with an increased perfusion index (p < 0.05). However, the delta-SOFA score did not differ between the groups.
The perfusion index response to semiorthostatic stress in sepsis patients is a simple and inexpensive method that can be used to detect the sympathetic-microvascular response at the bedside and appears to have prognostic value.
评估半直立位应激时灌注指数的反应是否可用于监测脓毒症患者的交感神经 - 血管反应。
研究分为三组：A组（30名健康患者）、B组（30名无脓毒症的危重症患者）和C组（92名脓毒症患者）。患者接受半直立位应激试验（头部从0度抬高至60度），并评估血流动力学、灌注指数值和心脏超声数据。还对脓毒症患者的序贯器官衰竭评估（SOFA）评分进行了评估，比较试验后灌注指数升高和降低的患者。
试验后，A组的每搏输出量（p < 0.01）和心脏指数（p < 0.05）显著降低，心率（p < 0.05）和平均动脉压升高（p < 0.001）。B组和C组未观察到这些反应。在A组的个体分析中，灌注指数降低（p < 0.001），而在B组和C组中，反应是异质性的。此外，试验后灌注指数降低的脓毒症患者在72小时时的SOFA评分与灌注指数升高的组相比显著降低（p < 0.05）。然而，两组之间的SOFA评分变化值无差异。
脓毒症患者对半直立位应激的灌注指数反应是一种简单且廉价的方法，可用于在床边检测交感神经 - 微血管反应，并且似乎具有预后价值。
