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Maurin C, Portran P, Schweizer R, Allaouchiche B, Junot S, Jacquet-Lagrèze M, Fellahi JL. Effects of methylene blue on microcirculatory alterations following cardiac surgery: A prospective cohort study. Eur J Anaesthesiol 2022; 39:333-341. [PMID: 34610607 DOI: 10.1097/eja.0000000000001611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methylene blue is used as rescue therapy to treat catecholamine-refractory vasoplegic syndrome after cardiac surgery. However, its microcirculatory effects remain poorly documented. OBJECTIVE We aimed to study microcirculatory abnormalities in refractory vasoplegic syndrome following cardiac surgery with cardiopulmonary bypass and assess the effects of methylene blue. DESIGN A prospective open-label cohort study. SETTING 20-Bed ICU of a tertiary care hospital. PATIENTS 25 Adult patients receiving 1.5 mg kg-1 of methylene blue intravenously for refractory vasoplegic syndrome (defined as norepinephrine requirement more than 0.5 μg kg-1 min-1) to maintain mean arterial pressure (MAP) more than 65 mmHg and cardiac index (CI) more than 2.0 l min-1 m-2. MAIN OUTCOME MEASURES Complete haemodynamic set of measurements at baseline and 1 h after the administration of methylene blue. Sublingual microcirculation was investigated by sidestream dark field imaging to obtain microvascular flow index (MFI), total vessel density, perfused vessel density and heterogeneity index. Microvascular reactivity was assessed by peripheral near-infrared (IR) spectroscopy combined with a vascular occlusion test. We also performed a standardised measurement of capillary refill time. RESULTS Despite normalised CI (2.6 [2.0 to 3.8] l min-1 m-2) and MAP (66 [55 to 76] mmHg), patients with refractory vasoplegic syndrome showed severe microcirculatory alterations (MFI < 2.6). After methylene blue infusion, MFI significantly increased from 2.0 [0.1 to 2.5] to 2.2 [0.2 to 2.8] (P = 0.008), as did total vessel density from 13.5 [8.3 to 18.5] to 14.9 [10.1 to 14.7] mm mm-2 (P = 0.02) and perfused vessel density density from 7.4 [0.1 to 11.5] to 9.1 [0 to 20.1] mm mm-2 (P = 0.02), but with wide individual variation. Microvascular reactivity assessed by tissue oxygen resaturation speed also increased from 0.5 [0.1 to 1.8] to 0.7 [0.1 to 2.7]% s-1 (P = 0.002). Capillary refill time remained unchanged throughout the study. CONCLUSION In refractory vasoplegic syndrome following cardiac surgery, we found microcirculatory alterations despite normalised CI and MAP. The administration of methylene blue could improve microvascular perfusion and reactivity, and partially restore the loss of haemodynamic coherence. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04250389.
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Affiliation(s)
- Carole Maurin
- From the Service d'Anesthésie Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel (CM, PP, RS, MJ-L, J-LF), Service d'Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon (BA), APCSe, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon (SJ) and Laboratoire CarMeN, Inserm U1060, Université Claude Bernard Lyon 1, Campus Lyon Santé Est, Lyon, France (MJ-L, J-LF)
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Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients: An observational study. Eur J Anaesthesiol 2018; 34:688-694. [PMID: 28834795 DOI: 10.1097/eja.0000000000000684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. OBJECTIVE The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. DESIGN Prospective, observational study. SETTING Single-centre, tertiary university teaching hospital, Belgium. PATIENTS Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. INTERVENTION Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. MAIN OUTCOME MEASURES Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. RESULTS Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P < 0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min, P < 0.001]. After induction of anaesthesia, recovery times were longer [40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery was lower [114 (12 to 497) vs. 80 (3 to 271)% min, P < 0.001]. CONCLUSION After induction of anaesthesia, oxygen consumption was decreased. The longer recovery times and slower rates of recovery indicate impaired microvascular reactivity after induction of anaesthesia. TRIAL REGISTRATION The research project was registered at ClinicalTrials.gov (NCT02034682).
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Pan P, Liu DW, Su LX, He HW, Wang XT, Yu C. Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock. Chin Med J (Engl) 2018; 131:1158-1166. [PMID: 29722335 PMCID: PMC5956766 DOI: 10.4103/0366-6999.231524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Measurement of general microcirculation remains difficult in septic shock patients. The peripheral perfusion index (PI) and sublingual microcirculation monitoring are thought to be possible methods. This study was performed to determine whether assessing microcirculation by PI and a new parameter, proportion of perfusion vessel change rate (ΔPPV) from sublingual microcirculation monitoring, can be associated with patients' outcome. Methods: A prospective observational study was carried out, including 74 patients with septic shock in a mixed intensive care unit. Systemic hemodynamic variables were obtained at T0 and 6 h after (T6). PI and sublingual microcirculation indicators were obtained using a bedside monitor and a sidestream dark-field device, respectively. The t-test, analysis of variance, Mann-Whitney U-test, Kruskal-Wallis test, receiver operating characteristic curve analysis with the Hanley-McNeil test, survival curves using the Kaplan-Meier method, and the log-rank (Mantel-Cox) test were used to statistical analysis. Results: Systemic hemodynamics and microcirculation data were obtained and analyzed. Patients were divided into two groups based on whether the first 6 h lactate clearance (LC) was ≥20%; PI and ΔPPV were lower at T6 in the LC <20% group compared with LC ≥20% (PI: 1.52 [0.89, 1.98] vs. 0.79 [0.44, 1,81], Z = −2.514, P = 0.012; ΔPPV: 5.9 ± 15.2 vs. 17.9 ± 20.0, t = −2.914, P = 0.005). The cutoff values of PI and ΔPPV were 1.41% and 12.1%, respectively. The cutoff value of the combined indicators was 1.379 according to logistic regression. Area under the curve demonstrated 0.709 (P < 0.05), and the sensitivity and specificity of using combined indicators were 0.622 and 0.757, respectively. Based on the PI and ΔPPV cutoff, all the participants were divided into the following groups: (1) high PI and high ΔPPV group, (2) high PI and low ΔPPV group, (3) low PI and high ΔPPV group, and (4) low PI and low ΔPPV group. The highest Sequential Organ Failure Assessment score (14.5 ± 2.9) was in the low PI and low ΔPPV group (F = 13.7, P < 0.001). Post hoc tests showed significant differences in 28-day survival rates among these four groups (log rank [Mantel-Cox], 20.931; P < 0.05). Conclusion: PI and ΔPPV in septic shock patients are related to 6 h LC, and combining these two parameters to assess microcirculation can predict organ dysfunction and 28-day mortality in patients with septic shock.
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Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huai-Wu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chao Yu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Puchwein-Schwepcke AF, Schottmayer K, Mormanová Z, Dreyhaupt J, Genzel-Boroviczeny O, Thome UH. Permissive Hypercapnia Results in Decreased Functional Vessel Density in the Skin of Extremely Low Birth Weight Infants. Front Pediatr 2018; 6:52. [PMID: 29662873 PMCID: PMC5890181 DOI: 10.3389/fped.2018.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/23/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ventilator-induced lung injury with subsequent bronchopulmonary dysplasia remains an important issue in the care of extremely low-birth-weight infants. Permissive hypercapnia has been proposed to reduce lung injury. Hypercapnia changes cerebral perfusion, but its influence on the peripheral microcirculation is unknown. METHODS Data were collected from 12 infants, who were randomized to a permissive high PCO2 target group (HTG) or a control group (CG). Inclusion criteria were birth weight between 400 and 1,000 g, gestational age from 23 to 28 6/7 weeks, intubation during the first 24 h of life, and no malformations. The PCO2 target range was increased stepwise in both groups for weaning and was always 15 mmHg higher in the HTG than in the CG. Skin microvascular parameters were assessed non-invasively with sidestream dark field imaging on the inner side of the right arm every 24 h during the first week of life and on the 14th day of life. RESULTS Infants in the HTG had significantly higher max. PCO2 exposure, which was associated with a significantly and progressively reduced functional vessel density (FVD, p < 0.01). Moreover, there were significant differences in the diameter distribution over time, with HTG subjects having fewer small vessels but more large vessels. CONCLUSION High PCO2 levels significantly impaired peripheral microcirculation in preterm infants, as shown by a decreased FVD, presumably secondary to peripheral vasoconstriction. ISRCTN 56143743.
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Affiliation(s)
| | - Kristina Schottmayer
- Divsion of Neonatology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Zuzana Mormanová
- Divsion of Neonatology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Orsolya Genzel-Boroviczeny
- Divsion of Neonatology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich H Thome
- Divsion of Neonatology, University Hospital of Leipzig, Leipzig, Germany
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Obonyo NG, Fanning JP, Ng ASY, Pimenta LP, Shekar K, Platts DG, Maitland K, Fraser JF. Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review. Intensive Care Med Exp 2016; 4:38. [PMID: 27873263 PMCID: PMC5118377 DOI: 10.1186/s40635-016-0112-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/15/2016] [Indexed: 12/29/2022] Open
Abstract
Background Recent research has identified an increased rate of mortality associated with fluid bolus therapy for severe sepsis and septic shock, but the mechanisms are still not well understood. Fluid resuscitation therapy administered for sepsis and septic shock targets restoration of the macro-circulation, but the pathogenesis of sepsis is complex and includes microcirculatory dysfunction. Objective The objective of the study is to systematically review data comparing the effects of different types of fluid resuscitation on the microcirculation in clinically relevant animal models of lipopolysaccharide-induced sepsis. Methods A structured search of PubMed/MEDLINE and EMBASE for relevant publications from 1 January 1990 to 31 December 2015 was performed, in accordance with PRISMA guidelines. Results The number of published papers on sepsis and the microcirculation has increased steadily over the last 25 years. We identified 11 experimental animal studies comparing the effects of different fluid resuscitation regimens on the microcirculation. Heterogeneity precluded any meta-analysis. Conclusions Few animal model studies have been published comparing the microcirculatory effects of different types of fluid resuscitation for sepsis and septic shock. Biologically relevant animal model studies remain necessary to enhance understanding regarding the mechanisms by which fluid resuscitation affects the microcirculation and to facilitate the transfer of basic science discoveries to clinical applications.
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Affiliation(s)
- Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Angela S Y Ng
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Leticia P Pimenta
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kiran Shekar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David G Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn Maitland
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Paediatrics, Faculty of Medicine, Imperial College London, London, UK
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia. .,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Abstract
Survival after severe traumatic shock can be complicated by a number of pathophysiologic processes that ensue after the initial trauma. One of these is trauma-induced coagulopathy (TIC) whose onset may occur before initial fluid resuscitation. The pathogenesis of TIC has not yet been fully elaborated, but evolving evidence appears to link severe tissue hypoxia and damage to the endothelium as key factors, which evolve into measurable structural and biochemical changes of the endothelium resulting in a coagulopathic state. This paper will provide a general review of these linkages and identify knowledge gaps as well as suggest new approaches and areas of investigation, which may both limit the development of TIC as well as produce insights into its pathophysiology. A better understanding of these issues will be necessary in order to advance the practice of remote damage control resuscitation.
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Affiliation(s)
- Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI 48109, USA.
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Holley A, Lukin W, Paratz J, Hawkins T, Boots R, Lipman J. Review article: Part two: Goal-directed resuscitation--which goals? Perfusion targets. Emerg Med Australas 2012; 24:127-35. [PMID: 22487661 DOI: 10.1111/j.1742-6723.2011.01515.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Haemodynamic targets, such as cardiac output, mean arterial blood pressure and central venous oxygen saturations, remain crude predictors of tissue perfusion and oxygen supply at a cellular level. Shocked patients may appear adequately resuscitated based on normalization of global vital signs, yet they are still experiencing occult hypoperfusion. If targeted resuscitation is employed, appropriate use of end-points is critical. In this review, we consider the value of directing resuscitation at the microcirculation or cellular level. Current technologies available include sublingual capnometry, video microscopy of the microcirculation and near-infrared spectroscopy providing a measure of tissue oxygenation, whereas base deficit and lactate potentially provide a surrogate measure of the adequacy of global perfusion. The methodology and evidence for these technologies guiding resuscitation are considered in this narrative review.
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Affiliation(s)
- Anthony Holley
- Departments of Intensive Care Medicine Emergency Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia.
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Krite Svanberg E, Wollmer P, Andersson-Engels S, Åkeson J. Physiological influence of basic perturbations assessed by non-invasive optical techniques in humans. Appl Physiol Nutr Metab 2011; 36:946-57. [DOI: 10.1139/h11-119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
New non-invasive techniques enabling frequent or continuous assessments of various pathophysiological conditions might be used to improve in-hospital outcome by enabling earlier and more reliable bedside detection of medical deterioration. In this preclinical study, three modern non-invasive optical techniques, laser Doppler imaging (LDI), near-infrared spectroscopy (NIRS), and tissue viability imaging (TVI), were all evaluated with respect to the influence of basic physiological perturbations (including local changes in arm positioning, skin temperature, and regional blood flow conditions) on quasi simultaneously obtained values of skin perfusion, muscle tissue oxygenation (StO2), and skin blood volume, recorded in eighteen healthy volunteers. Skin perfusion measured by LDI responded prominently to changes in positioning of the arm, whereas muscle StO2 measured by NIRS did not change significantly. Total haemoglobin count (HbT) measured by NIRS and blood volume estimated by TVI both increased significantly on lowering of the limb. On local cooling, the perfusion and blood volume were both found to increase considerably, while StO2 and HbT did not change. Local heating induced a more than 10-fold increase in skin perfusion and a small increase in blood volume. On progressive venoarterial occlusion, the perfusion, StO2, HbT, and blood volume values decreased, after transient increases in HbT and blood volume before full arterial occlusion occurred, and all values approached the baseline level on release of the occlusion with a slight overshoot of the StO2. The results obtained have potential bearing on future utilization of these non-invasive techniques in the management of severely injured and (or) critically ill patients.
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Affiliation(s)
- Emilie Krite Svanberg
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, entrance 42, 3rd floor, SE – 205 02 Malmö, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jonas Åkeson
- Department of Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, entrance 42, 3rd floor, SE – 205 02 Malmö, Sweden
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The impact of induction of general anesthesia and a vascular occlusion test on tissue oxygen saturation derived parameters in high-risk surgical patients. J Clin Monit Comput 2011; 25:237-44. [PMID: 21948067 DOI: 10.1007/s10877-011-9301-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/29/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Tissue oxygen saturation (StO(2)) assessed using Near Infrared Spectroscopy and its derived parameters during a vascular occlusion test (VOT) can detect microvascular changes in septic shock patients. General anesthesia (GA) impacts microcirculation. Our aim was to study the effects of general anesthesia on StO(2) and StO(2) derived parameters obtained during VOT in patients referred for cardiac surgery. METHODS We studied 15 patients referred for cardiac surgery before and after induction of GA. Before GA induction, we also studied 15 healthy volunteers (non patients) in order to compare baseline physiological data between patients and healthy subjects. Hemodynamic and microcirculatory (StO(2), ischemic slope, reperfusion slope, and hyperemic response) data were recorded at each step. We used the Inspectra StO(2) system (Hutchinson Inc, MN, USA) with a sensor placed on the thenar eminence. StO(2) values were obtained at baseline and during a VOT. A sphyngomanometer was placed on the forearm above the StO(2) probe and the cuff was then rapidly inflated 30 mmHg above systolic pressure and was maintained inflated until the StO(2) value reached 40%. It was then rapidly deflated. RESULTS Healthy volunteers had significantly higher reperfusion slope than patients (348 [251-393] vs. 261 [185-279] %/min; P < 0.05). GA induction induced no significant change in StO(2) value compared to baseline (79 [75-85] vs. 80 [76-86]%; P = 0.57). We observed a significant decrease in ischemic slope (from -12 [-16--8] to -8 [-10--6] %/min; P = 0.004) and in reperfusion slope (from 261 [185-279] %/min to 164 [151-222] %/min; P = 0.008) suggesting a decrease in local metabolic rate and a negative impact on reperfusion reserve induced by anesthesia. CONCLUSION StO(2) derived parameters during a VOT are impacted by GA induction. These parameters may have potential for microcirculation assessment in patients undergoing surgery.
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Schneider AG, Hofmann L, Wuerzner G, Glatz N, Maillard M, Meuwly JY, Eggimann P, Burnier M, Vogt B. Renal perfusion evaluation with contrast-enhanced ultrasonography. Nephrol Dial Transplant 2011; 27:674-81. [PMID: 21690200 DOI: 10.1093/ndt/gfr345] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Contrast-enhanced ultrasonography (CEUS) is a novel imaging technique that is safe and applicable on the bedside. Recent developments seem to enable CEUS to quantify organ perfusion. We performed an exploratory study to determine the ability of CEUS to detect changes in renal perfusion and to correlate them with effective renal plasma flow. METHODS CEUS with destruction-refilling sequences was studied in 10 healthy subjects, at baseline and during infusion of angiotensin II (AngII) at low (1 ng/kg/min) and high dose (3 ng/kg/min) and 1 h after oral captopril (50 mg). Perfusion index (PI) was obtained and compared with the effective renal plasma flow (ERPF) obtained by parallel para-aminohippurate (PAH) clearance. RESULTS Median PI decreased from 188.6 (baseline) to 100.4 with low-dose AngII (-47%; P < 0.02) and to 66.1 with high-dose AngII (-65%; P < 0.01) but increased to 254.7 with captopril (+35%; P > 0.2). These changes parallelled those observed with ERPF, which changed from a median of 672.1 mL/min (baseline) to 572.3 (low-dose AngII, -15%, P < 0.05) and to 427.2 (high-dose AngII, -36%, P < 0.001) and finally 697.1 (captopril, +4%, P < 0.02). CONCLUSIONS This study demonstrates that CEUS is able to detect changes in human renal cortical microcirculation as induced by AngII infusion and/or captopril administration. The changes in perfusion indices parallel those in ERPF as obtained by PAH clearance.
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Affiliation(s)
- Antoine G Schneider
- Department of Internal Medicine, Division of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Restoring arterial pressure with norepinephrine improves muscle tissue oxygenation assessed by near-infrared spectroscopy in severely hypotensive septic patients. Intensive Care Med 2010; 36:1882-9. [DOI: 10.1007/s00134-010-2013-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Bezemer R, Klijn E, Khalilzada M, Lima A, Heger M, van Bommel J, Ince C. Validation of near-infrared laser speckle imaging for assessing microvascular (re)perfusion. Microvasc Res 2010; 79:139-43. [PMID: 20079750 DOI: 10.1016/j.mvr.2010.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/04/2010] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
The present study was conducted to compare laser speckle imaging (LSI) with sidestream dark field (SDF) imaging (i.e., capillary microscopy) so as to validate the use of LSI for assessing microvascular (re)perfusion. For this purpose, LSI and SDF measurements were performed on the human nail fold during gradual occlusion of the upperarm circulation to modify nail fold perfusion under controlled circumstances. Additionally, a vascular occlusion test was performed to test the ability of LSI to detect rapid changes in tissue perfusion during reactive hyperemia and a hyperthermic challenge was performed to measure LSI perfusion at maximum functional capillary density. Normalized LSI measurements (i.e., normalized to baseline is 100%) were shown to correlate positively with normalized SDF measurements (Pearson's r=0.92). This was supported by linear regression analysis (slope of 1.01, R(2)=0.85, p<0.001). During the vascular occlusion test, LSI perfusion decreased from 307+/-90 AU (baseline) to 42+/-8 AU (ischemia). Peak perfusion during reperfusion was 651+/-93 AU (212% of baseline), which had returned to baseline after 2 min. Hyperthermia increased LSI perfusion from 332+/-90 AU to 1067+/-256 AU (321% of baseline). The main finding was that changes in perfusion as measured by LSI correlated well with changes in capillary red blood cell velocities as measured by SDF imaging during controlled reduction of the (micro)vascular perfusion. It was further shown that LSI is capable of measuring tissue perfusion at high temporal and spatial resolution. In conclusion, LSI can be employed to accurately quantitate microvascular reactivity following ischemic and hyperthermic challenges.
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Affiliation(s)
- Rick Bezemer
- Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
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Holley A, Udy A, Lipman J, Paratz J. The microcirculation, regional blood flow and tissue oxygenation: will new technologies drive new resuscitation goals? Anaesth Intensive Care 2010; 37:700-2. [PMID: 19775031 DOI: 10.1177/0310057x0903700524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ruiz C, Hernandez G, Ince C. Diagnosis and Treatment of the Septic Microcirculation. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW The present review discusses the evolution of the microcirculation from a theoretical idea to a clinical concept, as a result of the introduction of direct in-vivo observation techniques. RECENT FINDINGS Technical proceedings in the acquisition and assessment of microcirculatory imaging are described, as well as the first report of in-vivo mitochondrial pO2 measurements. Experimental data on immune tolerance, leukocyte dynamics, vascular permeability and regional hypoxia have contributed to unravel the complex origin of microcirculatory alterations. Several reports have highlighted the concept of heterogeneity of microcirculatory blood flow observed within and between different microvascular beds. The previously reported prognostic value of microcirculatory alterations has now been expanded to the early phase of sepsis and in postoperative patients. Finally, a list of interventions in experimental and clinical settings is discussed with regard to their potency to influence microcirculatory changes in shock. SUMMARY Direct in-vivo observation of the microcirculation has enabled the construction of microcirculatory failure as a clinical concept in the critically ill. Aiming for promicrocirculatory recruitment strategies in order to improve outcome will be the challenge for the near future.
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Assessment of Perioperative Fluid Balance. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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