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A multimodal tissue perfusion measurement approach for the evaluation of the effect of pimobendan, an inodilator, in a porcine sepsis model
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International audience. Introduction: Tissue perfusion disorders are major pathophysiologic determinants of sepsis. Thus, early identification and treatment of these disorders remain an important goal to optimize the outcome of the patients. Pimobendan, an inodilator, may improve tissue perfusion. The aims of the study were: 1) to assess the effect of pimobendan on macrocirculation and perfusion and 2) to describe a multimodal approach to the assessment of perfusion in sepsis and compare the evolution of the perfusion parameters.Methods: Eighteen anesthetized female piglets (Sus domesticus) were equipped for macrocirculation monitoring (cardiac output, invasive arterial pressure). Sepsis was induced by an infusion of Pseudomonas aeruginosa. After the occurrence of shock (mean arterial pressure < 40 mmHg), animals were resuscitated with fluids, noradrenaline and/or dobutamine. Eight pigs received pimobendan (0.25 mg/kg IV) at the start of resuscitation maneuvers, the others received saline. Tissue perfusion was assessed using temperature gradients measured with infrared thermography (TG = core temperature – tarsus temperature), urethral perfusion index (uPI) derived from photoplethysmography and sublingual microcirculation, assessed with a Sidestream dark field imaging device, giving the following parameters: De Backer score (DBs), proportion of perfused vessels (PPV), microvascular flow index (MFI) and heterogeneity index (HI). Systemic biomarkers of tissue perfusion (arterial lactate and ScvO2) were also measured. Results: The infusion of bacteria was associated with a significant decrease in uPI and increase in MFI. Shock was associated with a significant decrease in uPI, PPV and ScvO2 and a significant rise in TG. Only TG could significantly predict an increase in lactate. Pimobendan did not improve tissue perfusion nor macrocirculation. It did not allow a reduction in the amount of noradrenaline and fluids administered. In all animals, resuscitation was associated with a significant increase in uPI, DBs, MFI, lactate and ScvO2. There were fair correlations between the different perfusion parameters. Conclusions: In this model, pimobendan did not show any benefit. The multimodal approach allowed the detection of tissue perfusion alteration but only temperature gradients predicted the increase in lactatemia. The variability of the intensity of shock and data obtained precludes any definitive conclusion regarding a potential superiority of one method over the others.
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