Evaluation of the sublingual microcirculation in cardiogenic shock

Abstract

Objectives: Orthogonal polarized spectral imaging-and sidestream darkfield-technique have enabled visual evaluation of the microcirculation. Different investigators described microcirculatory alterations, especially in surgical patients suffering from septic shock. We investigated the sublingual microcirculation in non-surgical patients admitted to our medical, intensive care unit (ICU).Methods: In 24 severely ill (APACHE-II Score: 27.8 ± 11.3), intubated patients admitted to our ICU the sublingual microcirculation was recorded with a handheld intravital microscope. Sublingual vessels were categorized according to their size (small: 10-25 µm; medium: 26-50 µm; large: 51-100 µm) and the flow in semiquantitative categories (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow).Results: Patients with cardiogenic shock (n = 7) had lower microflow compared with patients without cardiogenic shock (small p < 0.001, medium p < 0.001, large p = 0.003). Several other diseases, including diabetes and arterial hypertension, age, gender, had no influence. In general, patients with a flow less than 3 in the small vessels showed higher arterial blood lactate levels (p = 0.043) compared to continuous flow.Conclusions: A consequence of cardiogenic shock is the impairment of microcirculation with organ hypoperfusion. We observed that cardiac output is correlated to disturbance in microflow in the smallest vessels. On-line evaluation of microcirculation in vivo may be a valid tool for optimizing therapeutic measures in high risk patients.Additional online material may be found at: http://www.kim1.uniklinik-jena.de/Microcirculation.html.

Changes in sublingual microcirculatory flow index and vessel density on ascent to altitude

“…The scoring system was developed primarily to study the pathophysiology of sepsis (Boerma et al 2005), in which a heterogeneous picture of both reduced and increased flow occurs (Elbers & Ince, 2006). Microcirculatory flow index scoring has been applied to other pathological conditions (van Beers et al 2008;Jung et al 2009;Lam et al 2009), but such measures have yet to be critically evaluated.…”

Applicability of quantitative optical imaging techniques for intraoperative perfusion diagnostics: a comparison of laser speckle contrast imaging, sidestream dark-field microscopy, and optical coherence tomography

“…Optical monitoring and imaging techniques have emerged as powerful diagnostic tools in different fields of medicine, such as ophthalmology for visualizing retinal vasculature, 8 anesthesiology for diagnosing shock in critically ill patients, 9 and neurology for cerebral perfusion imaging. 10 Due to their minimally invasive character and real-time visualization with high-contrast, these techniques could be of great advantage in intraoperative settings.…”

Microcirculation in cardiogenic shock: from scientific bystander to therapy target

“…This has been made possible because of the development of novel techniques to either directly visualize or indirectly evaluate microvascular perfusion [2]. In CS, microvascular alterations have been observed, resulting in a decrease of vessel density, the proportion of perfused capillaries, or microvascular flow [3,4]. Different treatment strategies, including pharmacological interventions and mechanical assist devices, may lead to microcirculatory improvement in CS [5-7].…”