Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy

Tytgat, Stefaan H.A.J.; Zee, David C. van der; İnce, Can; Milstein, Dan M.J.

doi:10.1007/s00464-013-2927-2

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Using HVM, microvascular beds of different types of mucosa and solid organ surfaces can be visualized directly up to a depth of ~1 mm, in real-time, and non-invasively at the patient's bedside. In neonates and children, microcirculatory imaging can be acquired from the buccal and sublingual mucosa (11, 12). In neonates, transcutaneous measurements (e.g., upper inner arm, axilla, ear conch, fossa triangularis) are also possible (13).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Microcirculation With Handheld Vital Microscopy in Critically Ill Neonates and Children: Evolution of the Technique and Its Potential for Critical Care

et al. 2019

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Assuring adequate tissue oxygenation in the critically ill, but still developing child is challenging. Conventional hemodynamic monitoring techniques fall short in assessing tissue oxygenation as these are directed at the macrocirculation and indirect surrogates of tissue oxygenation. The introduction of handheld vital microscopy (HVM) has allowed for the direct visualization of the microcirculation and with this has offered insight into tissue oxygenation on a microcirculatory level. Since its introduction, technical improvements have been made to HVM, to both hardware and software, and guidelines have been developed through expert consensus on image assessment and analysis. Using HVM, the microcirculation of the skin, the buccal mucosa, and the sublingual mucosa of healthy and (critically) ill neonates and children have been visualized and investigated. Yet, integration of HVM in hemodynamic monitoring has been limited due to technical shortcomings. Only superficial microcirculatory beds can be visualized, inter-observer and intra-observer variabilities are not accounted for and image analysis happens offline and is semi-automated and time-consuming. More importantly, patients need to be cooperative or fully sedated to prevent pressure and movement artifacts, which is often not the case in children. Despite these shortcomings, observational research with HVM in neonates and children has revealed the following: (1) age-related developmental changes in the microcirculation, (2) loss of hemodynamic coherence, i.e., microcirculatory disturbances in the presence of a normal macrocirculation and, (3) microcirculatory disturbances which were independently associated with increased mortality risk. Although these observations underline the importance of microcirculatory monitoring, several steps have to be taken before integration in the decision process during critical care can happen. These steps include technological innovations to ease the use of HVM in the pediatric age group, measuring additional functional parameters of microvascular blood flow and integrated automated analysis software. As a next step, reference values for microcirculatory parameters need to be established, while also accounting for developmental changes. Finally, studies on microcirculatory guided therapies are necessary to assess whether the integration of microcirculatory monitoring will actually improve patient outcome. Nevertheless, HVM remains a promising, non-invasive tool to help physicians assure tissue oxygenation in the critically ill child.

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Section: Introductionmentioning

confidence: 99%

Assessing the Microcirculation With Handheld Vital Microscopy in Critically Ill Neonates and Children: Evolution of the Technique and Its Potential for Critical Care

et al. 2019

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“…Our results suggest that the vasoconstrictor response was more pronounced during an acute increase in arterial PaO 2 rather than after a more sustained exposure. Of note, continuous monitoring of the microcirculation in the same region of sublingual mucosa is likely to be more sensitive in detecting even minute variations in vessel density compared to intermittent measurements, as it excludes any variability related to the random selection of different areas, albeit averaged over three samples [31, 32]. …”

Section: Discussionmentioning

confidence: 99%

Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study

et al. 2017

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BackgroundThe normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of ‘relative hypoxia’ which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygen species (ROS) may be involved in this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients.MethodsIn this prospective, observational study, 20 hemodynamically stable, mechanically ventilated patients with inspired oxygen concentration (FiO2) ≤0.5 and PaO2/FiO2 ≥ 200 mmHg underwent a 2-hour exposure to hyperoxia (FiO2 1.0). A further 20 patients acted as controls. Serum EPO was measured at baseline, 24 h and 48 h. Serum glutathione (antioxidant) and ROS levels were assessed at baseline (t0), after 2 h of hyperoxia (t1) and 2 h after returning to their baseline FiO2 (t2). The microvascular response to hyperoxia was assessed using sublingual sidestream dark field videomicroscopy and thenar near-infrared spectroscopy with a vascular occlusion test.ResultsEPO increased within 48 h in patients exposed to hyperoxia from 16.1 [7.4–20.2] to 22.9 [14.1–37.2] IU/L (p = 0.022). Serum ROS transiently increased at t1, and glutathione increased at t2. Early reductions in microvascular density and perfusion were seen during hyperoxia (perfused small vessel density: 85% [95% confidence interval 79–90] of baseline). The response after 2 h of hyperoxia exposure was heterogeneous. Microvascular perfusion/density normalized upon returning to baseline FiO2.ConclusionsA two-hour exposure to hyperoxia in critically ill patients was associated with a slight increase in EPO levels within 48 h. Adequately controlled studies are needed to confirm the effect of short-term hyperoxia on erythropoiesis.Trial registrationClinicalTrials.gov (www.clinicaltrials.gov), NCT02481843, registered 15th June 2015, retrospectively registered

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“…25,26 In a previous study, we assessed the effects of the PP on the sublingual vasculature during laparoscopic pyloromyotomies. 3 The CO 2 gas PP affected the microcirculatory perfusion by altering the microvascular diameter but left perfused vessel density, an oxygen diffusion-related parameter, unhindered. We concluded that these findings suggest that laparoscopic pyloromyotomy in young infants is safe, as the elevated blood CO 2 levels triggered no robust perfusion changes.…”

Section: Discussionmentioning

confidence: 99%

“…2 In a recent report we evaluated the effect of the PP on the sublingual microcirculation. 3 Installation of a CO 2 gas PP during laparoscopic pyloromyotomy altered microcirculatory perfusion by inducing changes in microvascular diameter but did not alter microcirculation density. We concluded that, based on these findings, it is justified to continue performing laparoscopic pyloromyotomies in young infants, as no robust perfusion changes were triggered by the elevated partial pressure of arterial CO 2 levels that indicate altered hemodynamics to the head and neck region.…”

Section: Introductionmentioning

confidence: 99%

Brain Oxygenation During Laparoscopic Correction of Hypertrophic Pyloric Stenosis

Tytgat

Stolwijk

Keunen

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy

Abstract: The installation of CO2 gas PP during laparoscopic pyloromyotomy procedures regulates microcirculatory perfusion by inducing changes in microvascular diameters but does not alter microcirculation density in neonates.

Cited by 12 publications

References 31 publications

Assessing the Microcirculation With Handheld Vital Microscopy in Critically Ill Neonates and Children: Evolution of the Technique and Its Potential for Critical Care

Assessing the Microcirculation With Handheld Vital Microscopy in Critically Ill Neonates and Children: Evolution of the Technique and Its Potential for Critical Care

Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study

Brain Oxygenation During Laparoscopic Correction of Hypertrophic Pyloric Stenosis

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