Monitoring of the microcirculation in children undergoing major abdominal and thoracic surgery: A pilot study

Wagner, Marie; Anzinger, Eveline; Hey, Florian; Reiter, Karl; Wermelt, Julius Z.; Pastor-Villaescusa, Belén; Genzel‐Boroviczény, Orsolya; Nußbaum, Claudia

doi:10.3233/ch-221617

Cited by 7 publications

(1 citation statement)

References 46 publications

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“…Monitoring pediatric patients during high-risk surgeries depends on optimizing the macrocirculation. In a study completed by Wagner et al ( 52 ), the authors addressed the feasibility of monitoring the microcirculation using handheld vital microscopy in a small group of pediatric patients. The microcirculation was assessed at four-time points during the perioperative period and was coupled with serum glycocalyx markers (syndecan-1 and hyaluronan).…”

Section: Perioperativementioning

confidence: 99%

End organ perfusion and pediatric microcirculation assessment

Arteaga,

Crow

2023

Front. Pediatr.

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Cardiovascular instability and reduced oxygenation are regular perioperative critical events associated with anesthesia requiring intervention in neonates and young infants. This review article addresses the current modalities of assessing this population's adequate end-organ perfusion in the perioperative period. Assuring adequate tissue oxygenation in critically ill infants is based on parameters that measure acceptable macrocirculatory hemodynamic parameters such as vital signs (mean arterial blood pressure, heart rate, urinary output) and chemical parameters (lactic acidosis, mixed venous oxygen saturation, base deficit). Microcirculation assessment represents a promising candidate for assessing and improving hemodynamic management strategies in perioperative and critically ill populations. Evaluation of the functional state of the microcirculation can parallel improvement in tissue perfusion, a term coined as “hemodynamic coherence”. Less information is available to assess microcirculatory disturbances related to higher mortality risk in critically ill adults and pediatric patients with septic shock. Techniques for measuring microcirculation have substantially improved in the past decade and have evolved from methods that are limited in scope, such as velocity-based laser Doppler and near-infrared spectroscopy, to handheld vital microscopy (HVM), also referred to as videomicroscopy. Available technologies to assess microcirculation include sublingual incident dark field (IDF) and sublingual sidestream dark field (SDF) devices. This chapter addresses (1) the physiological basis of microcirculation and its relevance to the neonatal and pediatric populations, (2) the pathophysiology associated with altered microcirculation and endothelium, and (3) the current literature reviewing modalities to detect and quantify the presence of microcirculatory alterations.

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Section: Perioperativementioning

confidence: 99%

End organ perfusion and pediatric microcirculation assessment

Arteaga,

Crow

2023

Front. Pediatr.

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Association between Inflammation, Glycocalyx Biomarkers, and Endothelial Function in Children with Hypercholesterolemia

Pastor-Villaescusa,

Meier,

Ruske

et al. 2024

Ann Nutr Metab

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Introduction: Hypercholesterolemia is a risk factor for premature arteriosclerosis. Inflammation and oxidative stress are thought to contribute to endothelial dysfunction preceding vasculopathy. We investigated the association between inflammation, glycocalyx biomarkers, endothelial function and vascular parameters in children with hypercholesterolemia. Methods: In 22 patients (LDL-cholesterol > 130 mg/dl; median age [IQR]: 13 [2.3] years) and 22 controls (13 [2.5] years) tumor necrosis factor-alpha (TNF-α), oxidized cholesterol (oxLDL), and glycocalyx biomarkers (Syndecan-1, Hyaluronan) were measured using immunoassays. Endothelial function was assessed by peripheral arterial tonometry, sublingual glycocalyx and microcirculation by videomicroscopy and carotid intima media thickness by ultrasound. Results: OxLDL was significantly higher in patients (78.9 [38.2] vs. 50.3 [16.6] U/l, p=0.002), whereas all other experimental parameters were comparable between groups. Multivariate analysis revealed a significant association of Syndecan-1 with TNF-α (β=0.75, p<0.001) and with hypercholesterolemia (β=0.31, p=0.030). The interaction term combining TNF-α and hypercholesterolemia showed a significant effect (p=0.034). Sex was an independent predictor of endothelial function. Conclusion: The combined effect of hypercholesterolemia and inflammation on glycocalyx perturbation and the impact of sex in the premature development of arteriosclerosis deserve further evaluation. Therapeutic approaches tackling low grade systemic inflammation-may offer potential to prevent or delay progression of CVD and cardiovascular complications.

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A normative blood velocity model in the exchange microvessels for discriminating health from disease: Healthy controls versus COVID-19 cases

Koutsiaris

Riri

Boutlas

et al. 2023

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A usual practice in medicine is to search for “biomarkers” which are measurable quantities of a normal or abnormal biological process. Biomarkers can be biochemical or physical quantities of the body and although commonly used statistically in clinical settings, it is not usual for them to be connected to basic physiological models or equations. In this work, a normative blood velocity model framework for the exchange microvessels was introduced, combining the velocity-diffusion (V-J) equation and statistics, in order to define the normative range (NR) and normative area (NA) diagrams for discriminating normal (normemic) from abnormal (hyperemic or underemic) states, taking into account the microvessel diameter D. This is different from the usual statistical processing since there is a basis on the well-known physiological principle of the flow diffusion equation. The discriminative power of the average axial velocity model was successfully tested using a group of healthy individuals (Control Group) and a group of post COVID-19 patients (COVID-19 Group).

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Monitoring of the microcirculation in children undergoing major abdominal and thoracic surgery: A pilot study

Cited by 7 publications

References 46 publications

End organ perfusion and pediatric microcirculation assessment

End organ perfusion and pediatric microcirculation assessment

Association between Inflammation, Glycocalyx Biomarkers, and Endothelial Function in Children with Hypercholesterolemia

A normative blood velocity model in the exchange microvessels for discriminating health from disease: Healthy controls versus COVID-19 cases

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