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Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2010

Open Access 01-12-2010 | Case report

Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management

Authors: Bernd Saugel, Andreas Umgelter, Friedrich Martin, Veit Phillip, Roland M Schmid, Wolfgang Huber

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2010

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Abstract

Systemic Capillary Leak Syndrome (SCLS) is a rare disorder characterized by increased capillary hyperpermeability leading to hypovolemic shock due to a markedly increased shift of fluid and protein from the intravascular to the interstitial space. Hemoconcentration, hypoalbuminemia and a monoclonal gammopathy are characteristic laboratory findings. Here we present a patient who suffered from SCLS with hypovolemic shock and compartment syndrome of both lower legs and thighs. Volume and catecholamine management was guided using transpulmonary thermodilution. Extended hemodynamic monitoring for volume and catecholamine management as well as monitoring of muscle compartment pressure is of crucial importance in SCLS patients.
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Literature
1.
go back to reference Clarkson B, Thompson D, Horwith M, Luckey EH: Cyclical edema and shock due to increased capillary permeability. The American journal of medicine. 1960, 29: 193-216. 10.1016/0002-9343(60)90018-8.CrossRefPubMed Clarkson B, Thompson D, Horwith M, Luckey EH: Cyclical edema and shock due to increased capillary permeability. The American journal of medicine. 1960, 29: 193-216. 10.1016/0002-9343(60)90018-8.CrossRefPubMed
2.
go back to reference Tahirkheli NK, Greipp PR: Treatment of the systemic capillary leak syndrome with terbutaline and theophylline. A case series. Annals of internal medicine. 1999, 130 (11): 905-909.CrossRefPubMed Tahirkheli NK, Greipp PR: Treatment of the systemic capillary leak syndrome with terbutaline and theophylline. A case series. Annals of internal medicine. 1999, 130 (11): 905-909.CrossRefPubMed
3.
go back to reference Chihara R, Nakamoto H, Arima H, Moriwaki K, Kanno Y, Sugahara S, Okada H, Suzuki H: Systemic capillary leak syndrome. Internal medicine (Tokyo, Japan). 2002, 41 (11): 953-956.CrossRef Chihara R, Nakamoto H, Arima H, Moriwaki K, Kanno Y, Sugahara S, Okada H, Suzuki H: Systemic capillary leak syndrome. Internal medicine (Tokyo, Japan). 2002, 41 (11): 953-956.CrossRef
4.
go back to reference Guidet B, Guerin B, Maury E, Offenstadt G, Amstutz P: Capillary leakage complicated by compartment syndrome necessitating surgery. Intensive care medicine. 1990, 16 (5): 332-333. 10.1007/BF01706361.CrossRefPubMed Guidet B, Guerin B, Maury E, Offenstadt G, Amstutz P: Capillary leakage complicated by compartment syndrome necessitating surgery. Intensive care medicine. 1990, 16 (5): 332-333. 10.1007/BF01706361.CrossRefPubMed
5.
go back to reference Cicardi M, Gardinali M, Bisiani G, Rosti A, Allavena P, Agostoni A: The systemic capillary leak syndrome: appearance of interleukin-2-receptor-positive cells during attacks. Annals of internal medicine. 1990, 113 (6): 475-477.CrossRefPubMed Cicardi M, Gardinali M, Bisiani G, Rosti A, Allavena P, Agostoni A: The systemic capillary leak syndrome: appearance of interleukin-2-receptor-positive cells during attacks. Annals of internal medicine. 1990, 113 (6): 475-477.CrossRefPubMed
6.
go back to reference Rondeau E, Sraer J, Bens M, Doleris LM, Lacave R, Sraer JD: Production of 5-lipoxygenase pathway metabolites by peripheral leucocytes in capillary leak syndrome (Clarkson disease). European journal of clinical investigation. 1987, 17 (1): 53-57. 10.1111/j.1365-2362.1987.tb01225.x.CrossRefPubMed Rondeau E, Sraer J, Bens M, Doleris LM, Lacave R, Sraer JD: Production of 5-lipoxygenase pathway metabolites by peripheral leucocytes in capillary leak syndrome (Clarkson disease). European journal of clinical investigation. 1987, 17 (1): 53-57. 10.1111/j.1365-2362.1987.tb01225.x.CrossRefPubMed
7.
go back to reference Cicardi M, Berti E, Caputo V, Radice F, Gardinali M, Agostoni A: Idiopathic capillary leak syndrome: evidence of CD8-positive lymphocytes surrounding damaged endothelial cells. The Journal of allergy and clinical immunology. 1997, 99 (3): 417-419. 10.1016/S0091-6749(97)70061-7.CrossRefPubMed Cicardi M, Berti E, Caputo V, Radice F, Gardinali M, Agostoni A: Idiopathic capillary leak syndrome: evidence of CD8-positive lymphocytes surrounding damaged endothelial cells. The Journal of allergy and clinical immunology. 1997, 99 (3): 417-419. 10.1016/S0091-6749(97)70061-7.CrossRefPubMed
8.
go back to reference Perry J, Balasubramanian S, Imray C: Systemic capillary leak syndrome resulting in compartment syndrome and the requirement for a surgical airway. Anaesthesia. 2009, 64 (6): 679-682. 10.1111/j.1365-2044.2009.05891.x.CrossRefPubMed Perry J, Balasubramanian S, Imray C: Systemic capillary leak syndrome resulting in compartment syndrome and the requirement for a surgical airway. Anaesthesia. 2009, 64 (6): 679-682. 10.1111/j.1365-2044.2009.05891.x.CrossRefPubMed
9.
go back to reference Prieto Valderrey F, Burillo Putze G, Martinez Azario J, Santana Ramos M: Systemic capillary leak syndrome associated with rhabdomyolysis and compartment syndrome. The American journal of emergency medicine. 1999, 17 (7): 743-744. 10.1016/S0735-6757(99)90179-1.CrossRefPubMed Prieto Valderrey F, Burillo Putze G, Martinez Azario J, Santana Ramos M: Systemic capillary leak syndrome associated with rhabdomyolysis and compartment syndrome. The American journal of emergency medicine. 1999, 17 (7): 743-744. 10.1016/S0735-6757(99)90179-1.CrossRefPubMed
10.
go back to reference Sanghavi R, Aneman A, Parr M, Dunlop L, Champion D: Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis. Anaesthesia and intensive care. 2006, 34 (3): 388-391.PubMed Sanghavi R, Aneman A, Parr M, Dunlop L, Champion D: Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis. Anaesthesia and intensive care. 2006, 34 (3): 388-391.PubMed
11.
go back to reference Katz SD: Blood volume assessment in the diagnosis and treatment of chronic heart failure. The American journal of the medical sciences. 2007, 334 (1): 47-52. 10.1097/MAJ.0b013e3180ca8c41.CrossRefPubMed Katz SD: Blood volume assessment in the diagnosis and treatment of chronic heart failure. The American journal of the medical sciences. 2007, 334 (1): 47-52. 10.1097/MAJ.0b013e3180ca8c41.CrossRefPubMed
12.
go back to reference McGee S, Abernethy WB, Simel DL: The rational clinical examination. Is this patient hypovolemic?. Jama. 1999, 281 (11): 1022-1029. 10.1001/jama.281.11.1022.CrossRefPubMed McGee S, Abernethy WB, Simel DL: The rational clinical examination. Is this patient hypovolemic?. Jama. 1999, 281 (11): 1022-1029. 10.1001/jama.281.11.1022.CrossRefPubMed
13.
go back to reference Marik PE, Baram M, Vahid B: Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008, 134 (1): 172-178. 10.1378/chest.07-2331.CrossRefPubMed Marik PE, Baram M, Vahid B: Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008, 134 (1): 172-178. 10.1378/chest.07-2331.CrossRefPubMed
14.
go back to reference Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL: Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest. 2003, 124 (5): 1900-1908. 10.1378/chest.124.5.1900.CrossRefPubMed Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL: Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest. 2003, 124 (5): 1900-1908. 10.1378/chest.124.5.1900.CrossRefPubMed
15.
go back to reference Sakka SG, Reinhart K, Meier-Hellmann A: Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med. 1999, 25 (8): 843-846. 10.1007/s001340050962.CrossRefPubMed Sakka SG, Reinhart K, Meier-Hellmann A: Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med. 1999, 25 (8): 843-846. 10.1007/s001340050962.CrossRefPubMed
16.
go back to reference Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A: Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000, 26 (2): 180-187. 10.1007/s001340050043.CrossRefPubMed Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A: Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med. 2000, 26 (2): 180-187. 10.1007/s001340050043.CrossRefPubMed
17.
go back to reference Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007, 35 (1): 64-68. 10.1097/01.CCM.0000249851.94101.4F.CrossRefPubMed Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007, 35 (1): 64-68. 10.1097/01.CCM.0000249851.94101.4F.CrossRefPubMed
18.
go back to reference Renner J, Gruenewald M, Brand P, Steinfath M, Scholz J, Lutter G, Bein B: Global end-diastolic volume as a variable of fluid responsiveness during acute changing loading conditions. Journal of cardiothoracic and vascular anesthesia. 2007, 21 (5): 650-654. 10.1053/j.jvca.2007.05.006.CrossRefPubMed Renner J, Gruenewald M, Brand P, Steinfath M, Scholz J, Lutter G, Bein B: Global end-diastolic volume as a variable of fluid responsiveness during acute changing loading conditions. Journal of cardiothoracic and vascular anesthesia. 2007, 21 (5): 650-654. 10.1053/j.jvca.2007.05.006.CrossRefPubMed
19.
go back to reference Muller L, Louart G, Bengler C, Fabbro-Peray P, Carr J, Ripart J, de La Coussaye JE, Lefrant JY: The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure. Anesthesia and analgesia. 2008, 107 (2): 607-613. 10.1213/ane.0b013e31817e6618.CrossRefPubMed Muller L, Louart G, Bengler C, Fabbro-Peray P, Carr J, Ripart J, de La Coussaye JE, Lefrant JY: The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure. Anesthesia and analgesia. 2008, 107 (2): 607-613. 10.1213/ane.0b013e31817e6618.CrossRefPubMed
20.
go back to reference Takabatake T: Systemic capillary leak syndrome. Internal medicine (Tokyo, Japan). 2002, 41 (11): 909-910.CrossRef Takabatake T: Systemic capillary leak syndrome. Internal medicine (Tokyo, Japan). 2002, 41 (11): 909-910.CrossRef
21.
go back to reference Droder RM, Kyle RA, Greipp PR: Control of systemic capillary leak syndrome with aminophylline and terbutaline. The American journal of medicine. 1992, 92 (5): 523-526. 10.1016/0002-9343(92)90749-2.CrossRefPubMed Droder RM, Kyle RA, Greipp PR: Control of systemic capillary leak syndrome with aminophylline and terbutaline. The American journal of medicine. 1992, 92 (5): 523-526. 10.1016/0002-9343(92)90749-2.CrossRefPubMed
22.
go back to reference Lambert M, Launay D, Hachulla E, Morell-Dubois S, Soland V, Queyrel V, Fourrier F, Hatron PY: High-dose intravenous immunoglobulins dramatically reverse systemic capillary leak syndrome. Crit Care Med. 2008, 36 (7): 2184-2187. 10.1097/CCM.0b013e31817d7c71.CrossRefPubMed Lambert M, Launay D, Hachulla E, Morell-Dubois S, Soland V, Queyrel V, Fourrier F, Hatron PY: High-dose intravenous immunoglobulins dramatically reverse systemic capillary leak syndrome. Crit Care Med. 2008, 36 (7): 2184-2187. 10.1097/CCM.0b013e31817d7c71.CrossRefPubMed
23.
go back to reference Amoura Z, Papo T, Ninet J, Hatron PY, Guillaumie J, Piette AM, Bletry O, Dequiedt P, Talasczka A, Rondeau E, Dutel JL, Wechsler B, Piette JC: Systemic capillary leak syndrome: report on 13 patients with special focus on course and treatment. The American journal of medicine. 1997, 103 (6): 514-519. 10.1016/S0002-9343(97)00272-6.CrossRefPubMed Amoura Z, Papo T, Ninet J, Hatron PY, Guillaumie J, Piette AM, Bletry O, Dequiedt P, Talasczka A, Rondeau E, Dutel JL, Wechsler B, Piette JC: Systemic capillary leak syndrome: report on 13 patients with special focus on course and treatment. The American journal of medicine. 1997, 103 (6): 514-519. 10.1016/S0002-9343(97)00272-6.CrossRefPubMed
24.
go back to reference Blade J: Clinical practice. Monoclonal gammopathy of undetermined significance. The New England journal of medicine. 2006, 355 (26): 2765-2770. 10.1056/NEJMcp052790.CrossRefPubMed Blade J: Clinical practice. Monoclonal gammopathy of undetermined significance. The New England journal of medicine. 2006, 355 (26): 2765-2770. 10.1056/NEJMcp052790.CrossRefPubMed
Metadata
Title
Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management
Authors
Bernd Saugel
Andreas Umgelter
Friedrich Martin
Veit Phillip
Roland M Schmid
Wolfgang Huber
Publication date
01-12-2010
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-18-38

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