Evaluation of sublingual microcirculation in children with dengue shock

Caixeta, Daniella Mancino da Luz; Fialho, Fernanda; Azevedo, Zina Maria Almeida de; Collett‐Solberg, Paulo Ferrez; Villela, Nivaldo Ribeiro

doi:10.6061/clinics/2013(07)26

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…MFI and PPV were lower in patients with plasma leakage than in those without when these parameters were assessed overall during the acute illness, and the reduction in PPV was borderline significant during the critical phase (illness day 4–6), but not earlier in the febrile phase. These findings are in agreement with the only other published report assessing the microcirculation in dengue, which showed altered perfusion and flow during the critical phase in 2 severe dengue cases [ 17 ]. In addition to flow disturbances, we have shown that eRBCs were visible in a quarter of the patients with dengue assessed, a finding not previously reported in SDF studies.…”

Section: Discussionsupporting

confidence: 93%

“…We hypothesized that clinical assessment of microvascular function in dengue could lead to identification of early markers of vascular leakage associated with disease progression. To date, visualization of the microcirculation with SDF imaging has been described in only 2 patients, both with dengue shock syndrome, and the findings showed severe microcirculatory abnormalities with reduced flow and perfusion [ 17 ]. However, neither the evolution of microcirculatory alterations during the disease course nor potential associations with clinical outcomes or endothelial activation markers have been evaluated.…”

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confidence: 99%

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Association of Microvascular Function and Endothelial Biomarkers With Clinical Outcome in Dengue: An Observational Study

Yacoub

Lam

et al. 2016

J Infect Dis.

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Background. The hallmark of severe dengue is increased microvascular permeability, but alterations in the microcirculation and their evolution over the course of dengue are unknown.Methods. We conducted a prospective observational study to evaluate the sublingual microcirculation using side-stream dark-field imaging in patients presenting early (<72 hours after fever onset) and patients hospitalized with warning signs or severe dengue in Vietnam. Clinical findings, microvascular function, global hemodynamics assessed with echocardiography, and serological markers of endothelial activation were determined at 4 time points.Results. A total of 165 patients were enrolled. No difference was found between the microcirculatory parameters comparing dengue with other febrile illnesses. The proportion of perfused vessels (PPV) and the mean flow index (MFI) were lower in patients with dengue with plasma than those without leakage (PPV, 88.1% vs 90.6% [P = .01]; MFI, 2.1 vs 2.4 [P = .007]), most markedly during the critical phase. PPV and MFI were correlated with the endothelial activation markers vascular cell adhesion molecule 1 (P < .001 for both) and angiopoietin 2 (P < .001 for both), negatively correlated.Conclusions. Modest microcirculatory alterations occur in dengue, are associated with plasma leakage, and are correlate with molecules of endothelial activation, angiopoietin 2 and vascular cell adhesion molecule 1.

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Section: Discussionsupporting

confidence: 93%

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confidence: 99%

Association of Microvascular Function and Endothelial Biomarkers With Clinical Outcome in Dengue: An Observational Study

Yacoub

Lam

et al. 2016

J Infect Dis.

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“…At present, alterations to microcirculatory flow patterns in dengue are largely unknown. In one case study from Brazil involving two patients with DSS, very abnormal microcirculatory patterns were identified, which improved following resolution of shock [ 94 ]. Our group in Vietnam is currently investigating the microcirculation using SDF technology in a large study of patients with suspected dengue, carrying out serial examinations from the early febrile phase throughout the evolution of the illness to see if the technique has prognostic value (Figure 2 ).…”

Section: Introductionmentioning

confidence: 99%

Predicting outcome from dengue

Yacoub

Wills

2014

BMC Med

102

101

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Dengue is emerging as one of the most abundant vector-borne disease globally. Although the majority of infections are asymptomatic or result in only a brief systemic viral illness, a small proportion of patients develop potentially fatal complications. These severe manifestations, including a unique plasma leakage syndrome, a coagulopathy sometimes accompanied by bleeding, and organ impairment, occur relatively late in the disease course, presenting a window of opportunity to identify the group of patients likely to progress to these complications. However, as yet, differentiating this group from the thousands of milder cases seen each day during outbreaks remains challenging, and simple and inexpensive strategies are urgently needed in order to improve case management and to facilitate appropriate use of limited resources. This review will cover the current understanding of the risk factors associated with poor outcome in dengue. We focus particularly on the clinical features of the disease and on conventional investigations that are usually accessible in mid-level healthcare facilities in endemic areas, and then discuss a variety of viral, immunological and vascular biomarkers that have the potential to improve risk prediction. We conclude with a description of several novel methods of assessing vascular function and intravascular volume status non-invasively.

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“…Pathogens and patients specificities may determine heterogeneous endothelium dysfunction. Patients with systemic chronic comorbidities, long lasting diseases, or malnourished ones may have alterations of the endothelial function (such as decreased NO syntheses); in a similar way, some pathogens such as dengue virus and Plasmodium are related to significant endothelium damage [ 12 , 49 , 62 , 63 ]. On these cases, impaired NO-dependent endothelial functions could preclude the beneficial effects of fluid resuscitation and even enhance its adverse effects, such as tissue edema [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Fluid resuscitation therapy in endotoxemic hamsters improves survival and attenuates capillary perfusion deficits and inflammatory responses by a mechanism related to nitric oxide

2014

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BackgroundRelative hypovolemia is frequently found in early stages of severe sepsis and septic shock and prompt and aggressive fluid therapy has become standard of care improving tissue perfusion and patient outcome. This paper investigates the role of the nitric oxide pathway on beneficial microcirculatory effects of fluid resuscitation.MethodsAfter skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.kg−1), male golden Syrian hamsters were fluid resuscitated and then sequentially treated with L-Nω-Nitroarginine and L-Arginine hydrochloride (LPS/FR/LNNA group). Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables including venular leukocyte rolling and adhesion. Macro-hemodynamic, biochemical and hematological parameters as well as survival rate were also evaluated. Endotoxemic hamsters treated with fluid therapy alone (LPS/FR group) and non-treated animals (LPS group) served as controls.ResultsFluid resuscitation was effective in reducing lipopolysaccharide-induced microcirculatory changes. After 3 hours of lipopolysaccharide administration, non-fluid resuscitated animals (LPS group) had the lowest functional capillary density (1% from baseline for LPS group vs. 19% for LPS/FR one; p <0.05). At the same time point, arteriolar mean internal diameter was significantly wider in LPS/FR group than in LPS one (100% vs. 50% from baseline). Fluid resuscitation also reduced leukocyte-endothelium interactions and sequestration (p <0.05 for LPS vs. LPS/FR group) and increased survival (median survival time: 2 and 5.5 days for LPS and LPS/FR groups, respectively; p <0.05). Nitric oxide synthase inhibition prevented these protective effects, while L-Arginine administration markedly restored many of them.ConclusionOur results suggest that the underlying mechanism of fluid therapy is the restoration of nitric oxide bioavailability, because inhibition of NOS prevented many of its beneficial effects. Nevertheless, further investigations are required in experimental models closer to conditions of human sepsis to confirm these results.

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Evaluation of sublingual microcirculation in children with dengue shock

Cited by 7 publications

References 9 publications

Association of Microvascular Function and Endothelial Biomarkers With Clinical Outcome in Dengue: An Observational Study

Association of Microvascular Function and Endothelial Biomarkers With Clinical Outcome in Dengue: An Observational Study

Predicting outcome from dengue

Fluid resuscitation therapy in endotoxemic hamsters improves survival and attenuates capillary perfusion deficits and inflammatory responses by a mechanism related to nitric oxide

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