Résumé
Microcirculatory alterations have been observed at the early phase of sepsis, although macrocirculation seems preserved. The aim of this study was to analyze the effect of crystalloid fluid therapy on mesenteric microcirculation, assessed by the confocal laser endomicroscope Cellvizio®, in a porcine model of endotoxinic shock. Methods: prospective endotoxinic shock (lipopolysaccharide LPS infusion) experimental trial. Piglets were divided into 3 groups: 6 in the sham group (no LPS injection, no fluid), 9 in the control group (LPS infusion, no fluid), and 6 in the crystalloids group (LPS infusion and fluid resuscitation with crystalloids). Fluid resuscitation consisted in a fluid bolus of 20 mL/kg 0.9% saline over 30 minutes followed by a10 mL/kg/h fluid rate over 4 hours. Mesenteric microcirculation was assessed using a confocal laser endomicroscope (Cellvizio®). Blood flow within capillaries was visually assessed according to the point of care microcirculation (POEM) score. Results: at baseline, the 3 groups were similar regarding hemodynamic, biological and microcirculatory parameters. At T360, the POEM score significantly decreased in the control and crystalloid groups, whereas it remained unchanged in the sham group (respectively 1.62±1.06, 1.2±0.45 and 5.0±0, p=0,011). There was no significant difference in cardiac output at T360 between the sham and crystalloids groups (3.1±0.8 vs 2.3±0.6, p=0.132) or between the control and crystalloids groups (2.0±0.6vs 2.3±0.6, p=0.90). Conclusion: there was no significant improvement of microcirculatory alterations after crystalloids resuscitation despite improvement in macrocirculatory parameters in early experimental sepsis.