Dargent Auguste, Fournel Isabelle, Jacquier Marine, Dumargne Hugo, Argaud Laurent, Quenot Jean-Pierre
Lyon Sud Hospital, Anesthesia and Critical Care Department, Hospices Civils de Lyon, Lyon, France.
APCSe Laboratory, VetAgro Sup UPSP, 2016.A101, Marcy l'Etoile, France.
Sci Rep. 2025 Aug 27;15(1):31554. doi: 10.1038/s41598-025-15813-z.
Fluid therapy is crucial in managing septic shock but may result in harmful fluid overload due to capillary leakage, causing interstitial fluid accumulation. Burns and endotoxemia models demonstrate that interstitium can reduce its hydrostatic pressure, increasing permeability, but this has not been clinically investigated in human sepsis. This study aimed to examine the changes in subcutaneous interstitial pressure (SIP) during sepsis. This prospective observational study involved adult patients admitted to the Intensive Care Unit (ICU) within 24 h, under sedation and mechanical ventilation, and who received < 50 ml/kg resuscitation. The septic shock group met the septic shock criteria, whereas the control group lacked sepsis or shock criteria (admission for non-traumatic coma). The SIP was measured using a subcutaneous transducer-tip probe. SIP was measured in 30 patients and was not significantly lower in septic shock: 1.69 ± 2.99 vs. 2.51 ± 2.39 mmHg in controls (p = 0.410). Among the 6 patients with a negative SIP, all but one were in the septic shock group, although the absolute difference was not significant (5 (33%) vs. 1 (7%), p = 0.169). Subcutaneous interstitial pressure was not significantly lower in septic shock patients, but sub-atmospheric SIP was more prevalent in this group, despite higher fluid balance. Further studies are required to clarify the role of interstitial pressure in capillary leakage during sepsis.
液体疗法在感染性休克的治疗中至关重要，但由于毛细血管渗漏可能导致有害的液体超负荷，引起间质液积聚。烧伤和内毒素血症模型表明，间质可降低其静水压，增加通透性，但在人类脓毒症中尚未进行临床研究。本研究旨在探讨脓毒症期间皮下间质压（SIP）的变化。这项前瞻性观察性研究纳入了在24小时内入住重症监护病房（ICU）、接受镇静和机械通气且复苏液体量<50 ml/kg的成年患者。感染性休克组符合感染性休克标准，而对照组不符合脓毒症或休克标准（因非创伤性昏迷入院）。使用皮下传感器尖端探头测量SIP。对30例患者进行了SIP测量，感染性休克患者的SIP并不显著降低：对照组为2.51±2.39 mmHg，感染性休克组为1.69±2.99 mmHg（p = 0.410）。在6例SIP为负值的患者中，除1例以外均在感染性休克组，尽管绝对差异不显著（5例（33%）对1例（7%），p = 0.169）。感染性休克患者的皮下间质压虽无显著降低，但该组中低于大气压的SIP更为普遍，尽管液体平衡量更高。需要进一步研究以阐明脓毒症期间间质压在毛细血管渗漏中的作用。
