Devices for assessing microcirculation

Edul, Vanina Kanoore; Gutiérrez, Facundo

doi:10.1097/mcc.0000000000001044

Cited by 4 publications

(5 citation statements)

References 73 publications

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“…Recruitment and functional capillary density diffusion in circulatory shock tend to worsen in sepsis without intervention. Increasing or sustaining adequate functional capillary density is important as a compensatory mechanism to increase oxygen supply to tissues in patients with circulatory shock ( 22 ). A comparison between the baseline and 24 hours with and without milrinone.…”

Section: Resultsmentioning

confidence: 99%

Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock

Sarta-Mantilla,

Fernández-Sarmiento,

Acevedo

et al. 2024

Transl Pediatr

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Background The goal of fluid resuscitation and the use of inotropes in septic shock has traditionally focused on improving blood pressure and cardiac output, without considering the microcirculatory changes. Reaching macrocirculatory goals but with persistent microcirculatory abnormalities (hemodynamic incoherence) in septic shock has been associated with greater organ dysfunction and mortality. The objective of this study was to evaluate the microcirculation (flow and capillary density) and endothelial glycocalyx changes associated with the use of milrinone in children with septic shock, as well as their relationship with clinical variables and organ dysfunction. Methods A prospective cohort study from February 2022 to January 2023 at a university hospital (Fundación Cardioinfantil-Instituto de Cardiología). Sublingual video microscopy was used to evaluate capillary density, microvascular flow rates and perfused boundary region (PBR—inverse parameter of glycocalyx thickness—abnormal if >2.0 microns). The primary outcome was the association between microcirculation and endothelial glycocalyx changes related to the use of milrinone. Results A total of 140 children with a median age of two years [interquartile range (IQR) 0.58–12.1] were included. About 57.9% (81/140) of the patients received milrinone infusions. Twenty-four hours after receiving milrinone, the patients maintained functional capillary density (P<0.01) and capillary recruitment capacity (P=0.04) with no changes in capillary blood volume versus those who did not receive milrinone. Children under two years old who received milrinone had better 4–6-micron capillary density than older children [odds ratio (OR) 0.33; 95% confidence interval (95% CI): 0.12–0.89; P=0.02] and less endothelial glycocalyx degradation [adjusted OR (aOR) 0.34 95% CI: 0.11–0.99; P=0.04]. These changes persisted despite elevated ferritin (aOR 0.41; 95% CI: 0.18–0.93; P=0.03). Prolonged capillary refill and elevated lactate were correlated with microcirculation changes in both groups. The patients who died had the highest PBR levels (P=0.04). Conclusions Children with septic shock who receive milrinone infusions have microcirculation changes compared with those who do not receive them. The group that received milrinone was found to maintain functional capillary density and capillary recruitment capacity and have less endothelial glycocalyx degradation 24 hours after administration. These changes were present despite the inflammatory response and were more significant in those under two years of age.

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Section: Resultsmentioning

confidence: 99%

Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock

Sarta-Mantilla,

Fernández-Sarmiento,

Acevedo

et al. 2024

Transl Pediatr

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“…Laser Doppler flowmetry and laser speckle contrast imaging share similar underlying principle. [51] Both techniques utilize laser light to induce wavelength changes and generate distinct speckle patterns on stationary tissues and flowing blood cells. The intensity and frequency of these changes are directly linked to the quantity and velocity of the moving blood cells, enabling the visualization of microcirculatory blood flow perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, the clinical utility of all these monitoring tools is still limited. [41,51,55] The transition of microcirculation monitoring from a research tool to a bedside monitoring technique utilized by clinical practitioners remains a forthcoming challenge.…”

Section: Imagingmentioning

confidence: 99%

Research progress on microcirculatory disorders in septic shock: A narrative review

Wang,

Ding,

Wang

et al. 2024

Medicine

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Hemodynamic coherence plays a critical role in the outcomes of septic shock. Due to the potential negative consequences of microcirculatory disorders on organ failure and clinical outcomes, the maintenance of a balance between the macrocirculation and microcirculation is a topic of significant research focus. Although physical methods and specialized imaging techniques are used in clinical practice to assess microcirculation, the use of monitoring devices is not widespread. The integration of microcirculation research tools into clinical practice poses a significant challenge for the future. Consequently, this review aims to evaluate the impact of septic shock on the microcirculation, the methods used to monitor the microcirculation and highlight the importance of microcirculation in the treatment of critically ill patients. In addition, it proposes an evaluation framework that integrates microcirculation monitoring with macrocirculatory parameters. The optimal approach should encompass dynamic, multiparametric, individualized, and continuous monitoring of both the macrocirculation and microcirculation, particularly in cases of hemodynamic separation.

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“…However, the assessment of microcirculation parameters, in relation to microvascular flow and density, tissue perfusion and oxygenation, and glycocalyx integrity has been on the epicenter of intensive research with promising results. Hand-held vital microscopes (HVM) have been investigated for the visualization of the sublingual capillary network, providing a wealth of information in relation to blood flow characteristics, vascular density, and glycocalyx [ 136 , 137 ]. Contrast-enhanced ultrasound (CEUS) is a promising technique for the assessment of the effects of fluid resuscitation and vasopressor administration on the renal microcirculation, as it holds the benefit of directly assessing organ perfusion [ 138 , 139 ].…”

Section: Discussionmentioning

confidence: 99%

New Insights into the Fluid Management in Patients with Septic Shock

Moschopoulos

Dimopoulou

et al. 2023

Medicina

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The importance of fluid resuscitation therapy during the early stages of sepsis management is a well-established principle. Current Surviving Sepsis Campaign (SSC) guidelines recommend the early administration of intravenous crystalloid fluids for sepsis-related hypotension or hyperlactatemia due to tissue hypoperfusion, within the first 3 h of resuscitation and suggest using balanced solutions (BSs) instead of normal saline (NS) for the management of patients with sepsis or septic shock. Studies comparing BS versus NS administration in septic patients have demonstrated that BSs are associated with better outcomes including decreased mortality. After initial resuscitation, fluid administration has to be judicious in order to avoid fluid overload, which has been associated with increased mortality, prolonged mechanical ventilation, and worsening of acute kidney injury. The “one size fits all” approach may be “convenient” but it should be avoided. Personalized fluid management, based on patient-specific hemodynamic indices, provides the foundations for better patient outcomes in the future. Although there is a consensus on the need for adequate fluid therapy in sepsis, the type, the amount of administered fluids, and the ideal fluid resuscitation strategy remain elusive. Well-designed large randomized controlled trials are certainly needed to compare fluid choices specifically in the septic patient, as there is currently limited evidence of low quality. This review aims to summarize the physiologic principles and current scientific evidence regarding fluid management in patients with sepsis, as well as to provide a comprehensive overview of the latest data on the optimal fluid administration strategy in sepsis.

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Devices for assessing microcirculation

Cited by 4 publications

References 73 publications

Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock

Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock

Research progress on microcirculatory disorders in septic shock: A narrative review

New Insights into the Fluid Management in Patients with Septic Shock

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