Peripheral blood flow monitoring in an infant with septic shock

• Published in: Pediatrics international Vol. 56; no. 5; pp. 787 - 789
• Main Authors: Ishiguro, Akio, Sakazaki, Sayaka, Itakura, Ryuta, Fujinuma, Sumie, Oka, Shuntaro, Motojima, Yukiko, Sobajima, Hisanori, Tamura, Masanori
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.10.2014
• Subjects: Drug therapy; Humans; Infant, Newborn; laser Doppler flowmetry; Male; microcirculation; Pediatrics; Regional Blood Flow; Sepsis; septic shock; Shock, Septic - physiopathology; Skin - blood supply; septic shock; regional blood flow; laser Doppler flowmetry; microcirculation; sepsis
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.12345

Septic shock is associated with impaired vasoregulation, and treatment includes vasoactive drugs. Therefore, evaluation of vasoregulatory change is important. The present report describes the successful characterization of vasoregulatory change in response to a vasoactive drug during septic shock. A male infant born at 23 weeks' gestation developed septic shock. Severe hypotension developed, and treatment with colloid fluid and dopamine failed to increase blood pressure. With continuous measurement of skin blood flow using laser Doppler, noradrenaline was started. Based on changes in the blood flow, the dose was increased. At a dose of 1 μg/kg per min, skin blood flow in the foot decreased without any change in blood pressure. Subsequent blood transfusion succeeded in increasing both blood pressure and skin blood flow. It is concluded that decrease in foot blood flow reflects the vasoconstrictive effect of noradrenaline, although this finding must be validated in larger studies.