Microvascular function and rheologic changes in hyperdynamic sepsis

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Abstract
To investigate the rheologic changes and circulatory abnormalities at the microvascular level during severe sepsis. Prospective, controlled trial. Medical and surgical intensive care units of a university-affiliated hospital. Nine normal controls and eight adult patients with severe sepsis who met the study entrance criteria. Forearm blood flow was measured at rest and during reactive hyperemia by air plethysmography. Simultaneous hemodynamic measurements and blood samples for rheologic measurements were taken. Red blood cell deformability index was determined using a simple filtration procedure. Leukocyte aggregation in whole human blood was detected by using a leukergy test. Expression of the neutrophil adhesion molecule CD11b/CD18 was measured using a monoclonal antibody and flow cytometry. All data were taken within 24 hrs of the patient meeting criteria for entrance into the study. Reactive hyperemia in the forearm is significantly diminished in patients with sepsis, suggesting impaired microvascular blood flow. Rheologic changes, including impaired red blood cell deformability, increased leukocyte aggregation, and endothelial adherence, may contribute to this abnormality by compromising effective capillary cross-sectional area.