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Open Access 01-06-2014 | Research

Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock

Authors: Alexandre Lima, Michel E van Genderen, Jasper van Bommel, Eva Klijn, Tim Jansem, Jan Bakker

Published in: Critical Care | Issue 3/2014

Abstract

Introduction

Recent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to investigate whether nitroglycerin could correct the parameters of abnormal peripheral circulation in resuscitated circulatory shock patients.

Methods

This interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters. Nitroglycerin started at 2 mg/hour and doubled stepwise (4, 8, and 16 mg/hour) each 15 minutes until an improvement in peripheral perfusion was observed. Peripheral circulation parameters included capillary refill time (CRT), skin-temperature gradient (Tskin-diff), perfusion index (PI), and tissue oxygen saturation (StO₂) during a reactive hyperemia test (RincStO₂). Measurements were performed before, at the maximum dose, and after cessation of nitroglycerin infusion. Data were analyzed by using linear model for repeated measurements and are presented as mean (standard error).

Results

Of the 15 patients included, four patients (27%) responded with an initial nitroglycerin dose of 2 mg/hour. In all patients, nitroglycerin infusion resulted in significant changes in CRT, Tskin-diff, and PI toward normal at the maximum dose of nitroglycerin: from 9.4 (0.6) seconds to 4.8 (0.3) seconds (P <0.05), from 3.3°C (0.7°C) to 0.7°C (0.6°C) (P <0.05), and from [log] -0.5% (0.2%) to 0.7% (0.1%) (P <0.05), respectively. Similar changes in StO₂ and RincStO₂ were observed: from 75% (3.4%) to 84% (2.7%) (P <0.05) and 1.9%/second (0.08%/second) to 2.8%/second (0.05%/second) (P <0.05), respectively. The magnitude of changes in StO₂ was more pronounced for StO₂ of less than 75%: 11% versus 4%, respectively (P <0.05).

Conclusions

Dose-dependent infusion of nitroglycerin reverted abnormal peripheral perfusion and poor tissue oxygenation in patients following circulatory shock resuscitation. Individual requirements of nitroglycerin dose to improve peripheral circulation vary between patients. A simple and fast physical examination of peripheral circulation at the bedside can be used to titrate nitroglycerin infusion.

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Title: Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock
Authors: Alexandre Lima
Michel E van Genderen
Jasper van Bommel
Eva Klijn
Tim Jansem
Jan Bakker
Publication date: 01-06-2014
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13932

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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