الفهرس 
Impact of gelatins on perfusion of microcirculatory blood flow in patient with severe sepsis and septic shock
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Abstract
Introduction Microcirculatory alterations play a vital role in sepsis and persist despite correction of systemic hemodynamic parameters.Effective fluid resuscitation is a key component in the effective management of patients with septic shock with the goal to improve tissue perfusion. Objects The aim of this work is to compare and evaluate the influence of gelatin and saline on sublingual microcirculation in patients with severe sepsis and septic shock. Another objective is to assess its effects on the incidence of renal dysfunction and acid base disturbance. Methods Prospective, randomized, controlled study was conducted on 42 patients with severe sepsis and septic shock, Patients meeting inclusion criteria was randomly assigned to receive either gelatin 4% or saline 0.9%, both patients and investigators who analyzed microcirculatory data were blinded to study vii groups. Patients included received 500 ml of either solution every 30 minutes till reaching the goals of initial resuscitation, using a Sidestream Dark Field device microvascular flow index was determined before and 6 hours after resuscitation. Arterial blood pressure, heart rate, and the use of vasopressor therapy was recorded every 30 min during the first 6 h. Arterial blood samples were collected at three specific times: on admission before any fluid administration, 6 and 24 hours after initial resuscitation. Urea, creatinine and urine output was measured daily for the first 5 days after resuscitation