الفهرس 
Recruitment of microcirculation using albumin 20% and terlipressin in patients with septic shock: A randomized controlled double-blinded study
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Abstract
Sepsis is one of the major medical problems and is responsible for high morbidity and mortality. The 2018 update of the Surviving Sepsis Campaign guidelines recommends treatment with intravenous fluids, measurement of serum lactate concentration as a marker of illness severity, administration of vasopressors, obtaining blood cultures and administering broad‐spectrum antibiotics, all within the first hour. The usual targets for resuscitation of patients with septic shock are the macro-circulatory parameters; however, it is believed that restoration of macro-circulatory parameters is not sufficient to avoid organ failure unless it was associated with improved microcirculatory perfusion. As sepsis is also characterized by an enhanced activation of inflammatory and oxidative stress pathways, which leads to endothelial dysfunction and vascular hypo-reactivity, for its ability to counteract oxidative stress, albumin may represent not only a plasma expander but also an endothelium-modulating agent. In 2016 a study showed that terlipressin therapy was associated with good improvement in hemodynamic variables and kidney functions more than adrenaline in patients with refractory septic shock despite adequate fluid resuscitation and the use of norepinephrine.
Methods: A Randomized controlled double-blinded study was done in ICU 185 Cairo university hospitals, using microcirculation cameras’ parameters, vital signs, doses of inotropic support throughout the first 24 hours of admission, to assess efficacy of Albumin 20% and terlipressin in improving the outcomes in patients with septic shock.
Results: Combination of Albumin 20% and terlipressin for patients -with septic shock didn’t increase sublingual microcirculation parameters, caused a significant reduction in cardiac output, serum lactate. Total urine output and the 28-days mortality increased in this group.
Conclusion: Combination of Albumin 20% and terlipressin for patients -with septic shock on nor-epinepherine small dose- didn’t increase sublingual microcirculation parameters, caused a significant reduction in cardiac output and the 28-days mortality increased in this group