Microcirculatory Impairment Is Associated With Multiple Organ Dysfunction Following Traumatic Hemorrhagic Shock: The MICROSHOCK Study

Hutchings, Sam; Naumann, David N; Hopkins, Philip; Mellis, Clare; Riozzi, Paul; Sartini, Stefano; Mamuza, Jasna; Harris, Tim; Midwinter, Mark; Wendon, Julia

doi:10.1097/ccm.0000000000003275

Cited by 54 publications

(67 citation statements)

References 32 publications

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“…Microcirculatory perfusion disturbances are present in an early stage in patients following traumatic hemorrhagic shock [3,4,9]. However, contrasting results exist regarding the course of restoration following fluid resuscitation [3,4,9].…”

Section: Discussionmentioning

confidence: 99%

“…A process of deferred consent was approved by the research ethics committee [8]. Characteristics and serum analyses of syndecan-1 and soluble thrombomodulin [9,10] and microcirculatory perfusion measurements of these patients [4] were published previously.…”

Section: Study Protocolmentioning

confidence: 99%

“…Microcirculatory perfusion has previously been reported for 58 patients included in the Microshock study [4]. Briefly, sublingual microcirculatory perfusion was measured using non-invasive incident dark field (IDF) videomicroscopy (Cytocam, Braedius Medical, Huizen, the Netherlands).…”

Section: Microcirculatory Perfusion Measurementsmentioning

confidence: 99%

“…Microcirculatory videos were analyzed by a single operator using automated vascular analysis (AVA) v.3.02 (Microvision Medical, Amsterdam, The Netherlands) by manually tracing all vessels by hand. These video analyses give values for total vessel density (TVD), perfused vessel density (PVD) and proportion of perfused vessels (PPV) according to the current best practice guidelines for reporting microcirculatory variables [4]. Here, in vivo microcirculatory perfusion measurements of the 16 patients that were included in the present study were used for additional analysis.…”

Section: Microcirculatory Perfusion Measurementsmentioning

confidence: 99%

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In vitro endothelial hyperpermeability occurs early following traumatic hemorrhagic shock

Leeuwen

Naumann

Dekker

et al. 2020

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BACKGROUND: Endothelial hyperpermeability is suggested to play a role in the development of microcirculatory perfusion disturbances and organ failure following hemorrhagic shock, but evidence is limited. OBJECTIVE: To study the effect of plasma from traumatic hemorrhagic shock patients on in vitro endothelial barrier function. METHODS: Plasma from traumatic hemorrhagic shock patients was obtained at the emergency department (ED), the intensive care unit (ICU), 24 h after ICU admission and from controls (n = 8). Sublingual microcirculatory perfusion was measured using incident dark field videomicroscopy at matching time points. Using electric cell-substrate impedance sensing, the effects of plasma exposure on in vitro endothelial barrier function of human endothelial cells were assessed. RESULTS: Plasma from traumatic hemorrhagic shock patients collected at ED admission induced a 19% loss of in vitro endothelial resistance compared to plasma from controls (p < 0.001). This loss was due to reduced cell-cell contacts (p < 0.01). Plasma withdrawn at later time points did not affect endothelial barrier function (p > 0.99). Interestingly, in vitro endothelial resistance showed a positive association with in vivo microcirculatory perfusion (r = 0.56, p < 0.01). CONCLUSIONS: Plasma from traumatic hemorrhagic shock patients obtained following ED admission, but not at later stages, induced in vitro endothelial hyperpermeability. This coincided with in vivo microcirculatory perfusion disturbances.

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Section: Discussionmentioning

confidence: 99%

Section: Study Protocolmentioning

confidence: 99%

Section: Microcirculatory Perfusion Measurementsmentioning

confidence: 99%

Section: Microcirculatory Perfusion Measurementsmentioning

confidence: 99%

See 2 more Smart Citations

In vitro endothelial hyperpermeability occurs early following traumatic hemorrhagic shock

Leeuwen

Naumann

Dekker

et al. 2020

Self Cite

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“…Microcirculatory perfusion disturbances following hemorrhagic shock and fluid resuscitation are a major complication and associated with the development of multiple organ dysfunction and increased mortality. 1 Standard treatment of hemorrhagic shock involves control of bleeding followed by fluid resuscitation. A combination of crystalloids and blood products is given to improve reperfusion and oxygenation of ischemic tissue.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic interventions to restore microcirculatory perfusion following experimental hemorrhagic shock and fluid resuscitation: A systematic review

et al. 2020

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Comparison of sublingual microcirculatory parameters measured by sidestream darkfield videomicroscopy in anesthetized pigs and adult humans

Lala,

Homes,

Pratt

et al. 2023

Anim Models and Exp Med

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BackgroundThis study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy. The overarching aim of the work was to validate the pig as an experimental model of changes in microcirculatory function following traumatic haemorrhagic shock and resuscitation.MethodsFourteen large white pigs and 14 humans were recruited for the study. Sublingual sidestream darkfield videomicroscopy clips were captured in anesthetized pigs and conscious humans. Clips underwent manual analysis in Automated Vascular Analysis 3.2 software. The total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPVs) and microvascular flow index (MFI) were quantified. An independent samples t test was used for between species comparison of microcirculatory parameters.Results and ConclusionsConscious humans had a significantly lower TVD, PVD and MFI than anesthetized pigs. No significant difference in PPVs was observed between the species. Perfusion of the microcirculation is a critical determinant of tissue metabolic function and viability. Whilst it may not be surprising that some interspecies differences in the sublingual microcirculatory anatomy were identified between pig and human subjects, it is interesting to report the insignificant difference in PPVs. This direct microcirculatory measure represents a relative change which should hold translatable value across species. We therefore conclude the pig is a suitable model for microcirculatory research and may be a suitable species to investigate changes in microcirculatory perfusion following perturbations in cardiovascular homeostasis, for example during traumatic haemorrhagic shock and resuscitation.

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Microcirculatory Impairment Is Associated With Multiple Organ Dysfunction Following Traumatic Hemorrhagic Shock: The MICROSHOCK Study

Cited by 54 publications

References 32 publications

In vitro endothelial hyperpermeability occurs early following traumatic hemorrhagic shock

In vitro endothelial hyperpermeability occurs early following traumatic hemorrhagic shock

Therapeutic interventions to restore microcirculatory perfusion following experimental hemorrhagic shock and fluid resuscitation: A systematic review

Comparison of sublingual microcirculatory parameters measured by sidestream darkfield videomicroscopy in anesthetized pigs and adult humans

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