Alterations of conjunctival glycocalyx and microcirculation in non-septic critically ill patients

Pranskūnas, Andrius; Tamošuitis, Tomas; Balčiūnienė, Neringa; Damanskytė, Diana; Šneider, Edvin; Vitkauskienė, Astra; Širvinskas, Edmundas; Pilvinis, Vidas; Boerma, E. Christiaan

doi:10.1016/j.mvr.2018.02.004

Cited by 17 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with this notion, De Backer et al reported that microcirculatory alterations are less severe in the later phase of sepsis than in the earlier phase [28]. Microcirculatory and PBR derangements in our resuscitated sepsis cohort (only 10% in shock) were comparable to values in ICU patients with moderate disease severity reported by other groups [19,21,27,49]. Data regarding the regeneration of the eGC in both human and murine sepsis are missing.…”

Section: Discussionsupporting

confidence: 82%

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

et al. 2019

View full text Add to dashboard Cite

Background The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis. Methods This observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck™). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values. Results In septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002; PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated exceptionally well with paired PBR values obtained at the bedside (rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters correlated well with the markers of critical illness. Interestingly, no association was observed between the PBR values and established microcirculation parameters. Conclusion Our findings suggest that eGC damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis. Trial registration Retrospectively registered: Clinicaltrials.gov, NCT03960307 Electronic supplementary material The online version of this article (10.1186/s13054-019-2542-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 82%

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The sepsis-associated PBR increase measured in this study is consistent with changes observed in previous studies [18][19][20][32][33][34]. The current study shows that adjustment of PBR estimates to V RBC improved discrimination between the groups by about 50%.…”

Section: Endothelial Glycocalyx Damagesupporting

confidence: 91%

Identification of novel sublingual parameters to analyze and diagnose microvascular dysfunction in sepsis: the NOSTRADAMUS study

et al. 2021

View full text Add to dashboard Cite

Background The availability of handheld, noninvasive sublingual video-microscopes allows for visualization of the microcirculation in critically ill patients. Recent studies demonstrate that reduced numbers of blood-perfused microvessels and increased penetration of erythrocytes into the endothelial glycocalyx are essential components of microvascular dysfunction. The aim of this study was to identify novel microvascular variables to determine the level of microvascular dysfunction in sepsis and its relationship with clinical variables. Methods This observational, prospective, cross-sectional study included 51 participants, of which 34 critically ill sepsis patients were recruited from intensive care units of a university hospital. Seventeen healthy volunteers served as controls. All participants underwent sublingual videomicroscopy by sidestream darkfield imaging. A new developed version of the Glycocheck™ software was used to quantify vascular density, perfused boundary region (PBR-an inverse variable of endothelial glycocalyx dimensions), red blood cell (RBC) velocity, RBC content, and blood flow in sublingual microvessels with diameters between 4 and 25 µm. Results A detailed analysis of adjacent diameter classes (1 µm each) of vessels between 4 and 25 µm revealed a severe reduction of vascular density in very small capillaries (5–7 µm), which correlated with markers of sepsis severity. Analysis of RBC velocity (VRBC) revealed a strong dependency between capillary and feed vessel VRBC in sepsis patients (R2 = 0.63, p < 0.0001) but not in healthy controls (R2 = 0.04, p = 0.43), indicating impaired capillary (de-)recruitment in sepsis. This finding enabled the calculation of capillary recruitment and dynamic capillary blood volume (CBVdynamic). Moreover, adjustment of PBR to feed vessel VRBC further improved discrimination between sepsis patients and controls by about 50%. By combining these dynamic microvascular and glycocalyx variables, we developed the microvascular health score (MVHSdynamic™), which decreased from 7.4 [4.6–8.7] in controls to 1.8 [1.4–2.7] in sepsis patients (p < 0.0001) and correlated with sepsis severity. Conclusion We introduce new important diameter-specific quantification and differentiated analysis of RBC kinetics, a key to understand microvascular dysfunction in sepsis. MVHSdynamic, which has a broad bandwidth to detect microvascular (dys-) function, might serve as a valuable tool to detect microvascular impairment in critically ill patients.

show abstract

“…At the clinical level, there are two known methods of determining glycocalyx thickness: i) indirect visualization of the glycocalyx, and ii) determination of its degradation products in the circulation. 99 Indirect visualization utilizes in vivo video microscopy techniques, such as sidestream dark field imaging in conjunction with software, 100 allowing indirect assessment of EG thickness in sublingual microcirculation by measuring the penetration extent (referred to as the perfused boundary region) of flowing red blood cells into the EG. This technique is applied mainly to explore changes in glycocalyx thickness in the sublingual mucosa, which assumedly reflects the status of the whole-body vasculature.…”

Section: Techniques Utilized For Measurement Of Glycocalyxmentioning

confidence: 99%

Glycocalyx Degradation in Ischemia-Reperfusion Injury

Abassi

Armaly

Heyman³

2020

The American Journal of Pathology

View full text Add to dashboard Cite

Alterations of conjunctival glycocalyx and microcirculation in non-septic critically ill patients

Cited by 17 publications

References 20 publications

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Identification of novel sublingual parameters to analyze and diagnose microvascular dysfunction in sepsis: the NOSTRADAMUS study

Glycocalyx Degradation in Ischemia-Reperfusion Injury

Contact Info

Product

Resources

About