Early course of microcirculatory perfusion in eye and digestive tract during hypodynamic sepsis

Abstract

IntroductionThe aim of the study was to evaluate and compare the microcirculatory perfusion during experimental sepsis in different potentially available parts of the body, such as sublingual mucosa, conjunctiva of the eye, and mucosa of jejunum and rectum.MethodsPigs were randomly assigned to sepsis (n = 9) and sham (n = 4) groups. The sepsis group received a fixed dose of live Escherichia coli infusion over a 1-hour period (1.8 × 109/kg colony-forming units). Animals were observed 5 hours after the start of E. coli infusion. In addition to systemic hemodynamic assessment, we performed conjunctival, sublingual, jejunal, and rectal evaluation of microcirculation by using Sidestream Dark Field (SDF) videomicroscopy at the same time points: at baseline, and at 3 and 5 hours after the start of live E. coli infusion. Assessment of microcirculatory parameters of convective oxygen transport (microvascular flow index (MFI) and proportion of perfused vessels (PPV)), and diffusion distance (perfused vessel density (PVD) and total vessel density (TVD)) was done by using a semiquantitative method.ResultsInfusion of E. coli resulted in a hypodynamic state of sepsis associated with low cardiac output and increased systemic vascular resistance despite fluid administration. Significant decreases in MFI and PPV of small vessels were observed in sublingual, conjunctival, jejunal, and rectal locations 3 and 5 hours after the start of E. coli infusion in comparison with baseline variables. Correlation between sublingual and conjunctival (r = 0.80; P = 0.036), sublingual and jejunal (r = 0.80; P = 0.044), and sublingual and rectal (r = 0.79; P = 0.03) MFI was observed 3 hours after onset of sepsis. However, this strong correlation between the sublingual and other regions disappeared 5 hours after the start of E. coli infusion. Overall, the sublingual mucosa exhibited the most-pronounced alterations of microcirculatory flow in comparison with conjunctival, jejunal, and rectal microvasculature (P < 0.05).ConclusionsIn this pig model, a time-dependent correlation exists between sublingual and microvascular beds during the course of a hypodynamic state of sepsis.

Assessment of cerebral circulation in a porcine model of intravenously given E. coli induced fulminant sepsis

“…These observations are in accordance with the results of previous porcine experiments using E. coli [19–22]. Similar to our observations, Pranskunas and co-workers reported on a 2-fold increase of the systemic vascular resistance 5 h after injection of E.coli, accompanied by a gradual decrease of the cardiac index [20]. In a recent review models using continuous infusion of living bacteria are described as hypodynamic sepsis models [23].…”

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“…Lastly, we used the tongue as a window to observe the microcirculation. It is conceivable that other organs may express different microvascular abnormalities at baseline [18, 29], or in response to fluid administration [30]. …”

Screening for Infection - An Analysis of the Microcirculation in Term Newborns

“…Early alteration of microcirculatory blood flow was associated with poor outcome [6,7]. A time-dependent significant decrease in perfused vessels and microvascular flow index during a hypodynamic state of sepsis could be demonstrated in a pig model [8]. Moreover, it has been shown that microcirculatory dysfunction correlates with markers of endothelial activation in children suffering from meningococcal disease [9].…”