Characterization of buccal microvascular response in patients with septic shock

Abstract

Buccal laser Doppler flowmetry/visual light spectroscopy may be useful for tracing microvascular alterations in critically ill patients. The surgical stress response was associated with alterations in local flow with preserved microHbO2. However, in patients with septic shock, microHbO2 was reduced in the deep channel, probably muscular tissue, with no changes in microvascular flow.

Association of Microcirculation, Macrocirculation, and Severity of Illness in Septic Shock: A Prospective Observational Study to Identify Microcirculatory Targets Potentially Suitable for Guidance of Hemodynamic Therapy

“…We present results on patients with septic shock prospectively analyzed with a laser Doppler spectrophotometry system (O2C) on the day of ICU admission (T0), 24 hours later on day 2 (T24) and on day 4 of treatment (T72). Although previous trials used this device to monitor cerebral microcirculation during neurosurgical procedures 27 and buccal mucosa of patients with sepsis, 24 we applied this method for the first time in combination with VOT in critical care patients with septic shock.…”

“…8,26 Results are closely correlated with those of other blood flow measurement methods and correctly quantify relative changes in skin blood flow. 24,32 However, microcirculatory perfusion is site dependent 32 and intermitted hypoxia leads to altered metabolic signals with long-lasting effects. 33 Accordingly, the relatively poor reproducibility of VOT measurements (coefficient of variation 9.2% ± 1.7%) 25,32 is not surprising.…”

Man or Machine? The Clinimetric Properties of Laser Doppler Imaging in Burn Depth Assessment

“…33 The patient's general condition is an additional factor that may alter flux readings but which may be much more difficult to standardize. 34 Sepsis may give rise to peripheral vasodilatation; the use of vasopressors for cardiovascular support will give rise to peripheral vasoconstriction. Smoking has been shown to have rapid effects on the peripheral microvasculature and can dramatically reduce flow on LDI flux images.…”

Monitoring the microcirculation in the critically ill patient: reflectance spectroscopy

“…The method has been used clinically to assess the microvascular response in patients with septic shock [2], to monitor the effects of extreme anaemia [3] or flap viability [4] and to predict wound healing in burn injury [5]. …”