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Open Access 01-04-2012 | Research

Brachial artery reactivity in patients with severe sepsis: an observational study

Authors: Orren Wexler, Mary Anne M Morgan, Michael S Gough, Sherry D Steinmetz, Cynthia M Mack, Denise C Darling, Kathleen P Doolin, Michael J Apostolakos, Brian T Graves, Mark W Frampton, Xucai Chen, Anthony P Pietropaoli

Published in: Critical Care | Issue 2/2012

Abstract

Introduction

Ultrasound measurements of brachial artery reactivity in response to stagnant ischemia provide estimates of microvascular function and conduit artery endothelial function. We hypothesized that brachial artery reactivity would independently predict severe sepsis and severe sepsis mortality.

Methods

This was a combined case-control and prospective cohort study. We measured brachial artery reactivity in 95 severe sepsis patients admitted to the medical and surgical intensive care units of an academic medical center and in 52 control subjects without acute illness. Measurements were compared in severe sepsis patients versus control subjects and in severe sepsis survivors versus nonsurvivors. Multivariable analyses were also conducted.

Results

Hyperemic velocity (centimeters per cardiac cycle) and flow-mediated dilation (percentage) were significantly lower in severe sepsis patients versus control subjects (hyperemic velocity: severe sepsis = 34 (25 to 48) versus controls = 63 (52 to 81), P < 0.001; flow-mediated dilation: severe sepsis = 2.65 (0.81 to 4.79) versus controls = 4.11 (3.06 to 6.78), P < 0.001; values expressed as median (interquartile range)). Hyperemic velocity, but not flow-mediated dilation, was significantly lower in hospital nonsurvivors versus survivors (hyperemic velocity: nonsurvivors = 25 (16 to 28) versus survivors = 39 (30 to 50), P < 0.001; flow-mediated dilation: nonsurvivors = 1.90 (0.68 to 3.41) versus survivors = 2.96 (0.91 to 4.86), P = 0.12). Lower hyperemic velocity was independently associated with hospital mortality in multivariable analysis (odds ratio = 1.11 (95% confidence interval = 1.04 to 1.19) per 1 cm/cardiac cycle decrease in hyperemic velocity; P = 0.003).

Conclusions

Brachial artery hyperemic blood velocity is a noninvasive index of microvascular function that independently predicts mortality in severe sepsis. In contrast, brachial artery flow-mediated dilation, reflecting conduit artery endothelial function, was not associated with mortality in our severe sepsis cohort. Brachial artery hyperemic velocity may be a useful measurement to identify patients who could benefit from novel therapies designed to reverse microvascular dysfunction in severe sepsis and to assess the physiologic efficacy of these treatments.

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Title: Brachial artery reactivity in patients with severe sepsis: an observational study
Authors: Orren Wexler
Mary Anne M Morgan
Michael S Gough
Sherry D Steinmetz
Cynthia M Mack
Denise C Darling
Kathleen P Doolin
Michael J Apostolakos
Brian T Graves
Mark W Frampton
Xucai Chen
Anthony P Pietropaoli
Publication date: 01-04-2012
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2012
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc11223

At a glance: The STEP trials

Springer Medicine

Brachial artery reactivity in patients with severe sepsis: an observational study

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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