Personalized physiological medicine

İnce, Can

doi:10.1186/s13054-017-1907-7

Cited by 31 publications

(34 citation statements)

References 52 publications

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“…necessary point of contact with the tissue) and time-consuming semi-manual evaluation 11,12 . However, information about microcirculatory perfusion would be of great interest in intensive care to predict outcome and potentially guide therapy 13,14 .…”

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confidence: 99%

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Heßler

Nelis

Ertmer

et al. 2020

Sci Rep

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Microcirculatory disorders are crucial in pathophysiology of organ dysfunction in critical illness. Evaluation of sublingual microcirculation is not routinely conducted in daily practice due to timeconsuming analysis and susceptibility to artifacts. We investigated the suitability of optical coherence tomography angiography (octA) for contactless evaluation of sublingual microcirculation. Sublingual microcirculation was imaged in 10 healthy volunteers, using an OCTA device and an incident dark field (IDF) illumination microscopy (current gold standard). OCTA images were analyzed with regard to flow density and perfused vessel density (PVD byoctA). IDF videos were analyzed following current recommendations. Flow density was automatically extracted from OCTA images (whole en face 48.9% [43.2; 54.5]; central ring 52.6% [43.6; 60.6]). PVD byoctA did not differ from the PVD calculated from IDF videos (PVD byoctA 18.6 mm/mm² [18.0; 21.7]) vs. PVD byIDF 21.0 mm/mm² [17.5; 22.9]; p = 0.430). Analysis according to Bland-Altman revealed a mean bias of 0.95 mm/mm² (95% Confidence interval −1.34 to 3.25) between PVD byoctA and PVD byIDF with limits of agreement of −5.34 to 7.24 mm/mm². This study is the first to demonstrate the suitability of OCTA for evaluating sublingual microcirculation. comparison of the perfused vessel density between methods showed a plausible level of agreement. In recent years, research has highlighted the importance of the microcirculation (vessels smaller than 100 μm) in the pathophysiology of diseases and organ dysfunction in critical illness. It is known that blood flow in the microcirculation is often impaired in critically ill patients and altered blood flow in the microcirculation is associated with outcome 1-6. A decoupling of macro-and microcirculation ("loss of hemodynamic coherence"), as can occur, for example, in advanced stages of septic shock is of particular interest here 7. In such conditions, macrohemodynamic parameters such as cardiac output and perfusion pressure are no longer indicative of perfusion in the microcirculation. The aim of hemodynamic therapy should therefore be restoration not only of the macrocirculation but also the microcirculation 7. Hence the demand for bedside methods to monitor the microcirculation. Bedside analysis of the microcirculation became possible with the introduction of modern handheld video microscopes using sidestream dark field (SDF) imaging or incident dark field (IDF) illumination technology 8-10. Unfortunately, the analysis of the microcirculation has not yet become established in routine clinical practice, as video microscopy of capillary blood flow has so far been limited by artifacts (e.g.

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mentioning

confidence: 99%

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Heßler

Nelis

Ertmer

et al. 2020

Sci Rep

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“…It is known that many hemodynamic variables have marked interindividual variability and depend on other factors such as biometric factors and time of disease, and probably using fixed hemodynamic goals might have contributed to the negative results of this trial. We postulate that the best concept to be applied at the bedside in high-surgical risk patients is personalized hemodynamic management, based on adaptive multiparameter hemodynamic optimization strategies targeting individual normal values adapted to the clinical situation [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis

et al. 2018

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BackgroundPerioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications.MethodsA randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital. All adult patients undergoing high-risk cancer surgery who required intensive care unit admission were randomly allocated to a CI-guided GDHT group or to a usual care group. In the GDHT group, postoperative therapy aimed at CI ≥ 2.5 L/min/m2 using fluids, inotropes and red blood cells during the first 8 postoperative hours. The primary outcome was a composite endpoint of 30-day all-cause mortality and severe postoperative complications during the hospital stay. A meta-analysis was also conducted including all randomized trials of postoperative GDHT published from 1966 to May 2017.ResultsA total of 128 patients (64 in each group) were randomized. The primary outcome occurred in 34 patients of the GDHT group and in 28 patients of the usual care group (53.1% vs 43.8%, absolute difference 9.4 (95% CI, − 7.8 to 25.8); p = 0.3). During the 8-h intervention period more patients in the GDHT group received dobutamine when compared to the usual care group (55% vs 16%, p < 0.001). A meta-analysis of nine randomized trials showed no differences in postoperative mortality (risk ratio 0.85, 95% CI 0.59–1.23; p = 0.4; p for heterogeneity = 0.7; I2 = 0%) and in the overall complications rate (risk ratio 0.88, 95% CI 0.71–1.08; p = 0.2; p for heterogeneity = 0.07; I2 = 48%), but a reduced hospital length of stay in the GDHT group (mean difference (MD) – 1.6; 95% CI – 2.75 to − 0.46; p = 0.006; p for heterogeneity = 0.002; I2 = 74%).ConclusionsCI-guided hemodynamic therapy in the first 8 postoperative hours does not reduce 30-day mortality and severe complications during hospital stay when compared to usual care in cancer patients undergoing high-risk surgery.Trial registrationwww.clinicaltrials.gov, NCT01946269. Registered on 16 September 2013.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2055-4) contains supplementary material, which is available to authorized users.

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“…Advanced hemodynamic monitoring may be an essential tool in diagnosing the hemodynamic alterations and in achieving hemodynamic coherence [10,11]. Transpulmonary thermodilution technique was proven to be a reliable tool in assessing the hemodynamic status and in guiding fluid resuscitation in the critically ill [12,13].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Predictors for Sepsis-Induced Acute Kidney Injury: A Preliminary Study

Antal

Ștefănescu

Mleșnițe

et al. 2020

JCM

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The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which minimally invasive hemodynamic parameters may help identify patients at risk for sepsis-AKI. We included 71 patients with sepsis and septic shock. We performed the initial fluid resuscitation using local protocols and continued to give fluids guided by the minimally invasive hemodynamic parameters. We assessed the hemodynamic status by transpulmonary thermodilution technique. Sequential organ failure assessment (SOFA score) (AUC 0.74, 95% CI 0.61–0.83, p < 0.01) and cardiovascular SOFA (AUC 0.73, 95% CI 0.61–0.83, p < 0.01) were found to be predictors for sepsis-induced AKI, with cut-off values of 9 and 3 points respectively. Persistent low stroke volume index (SVI) ≤ 32 mL/m2/beat (AUC 0.67, 95% CI 0.54–0.78, p < 0.05) and global end-diastolic index (GEDI) < 583 mL/m2 (AUC 0.67, 95% CI 0.54–0.78, p < 0.05) after the initial fluid resuscitation are predictive for oliguria/anuria at 24 h after study inclusion. The combination of higher vasopressor dependency index (VDI, calculated as the (dobutamine dose × 1 + dopamine dose × 1 + norepinephrine dose × 100 + vasopressin × 100 + epinephrine × 100)/MAP) and norepinephrine, lower systemic vascular resistance index (SVRI), and mean arterial blood pressure (MAP) levels, in the setting of normal preload parameters, showed a more severe vasoplegia. Severe vasoplegia in the first 24 h of sepsis is associated with a higher risk of sepsis induced AKI. The SOFA and cardiovascular SOFA scores may identify patients at risk for sepsis AKI. Persistent low SVI and GEDI values after the initial fluid resuscitation may predict renal outcome.

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Personalized physiological medicine

Cited by 31 publications

References 52 publications

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis

Hemodynamic Predictors for Sepsis-Induced Acute Kidney Injury: A Preliminary Study

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