Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: A prospective observational cohort study

Buijs, Erik; Verboom, Elyse M.; Top, Anke P. C.; Andrinopoulou, Eleni‐Rosalina; Buysse, Corinne; İnce, Can; Tibboel, Dick

doi:10.1016/j.resuscitation.2013.10.024

Cited by 25 publications

(29 citation statements)

References 38 publications

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“…Currently, consensus meetings are being held to determine the optimal method to analyze and obtain functional microcirculatory parameters from the images obtained by hand-held videomicroscopy. Several studies in pediatric patients have addressed the microcirculation in various disease states and different age groups [47–49]. …”

Section: Introductionmentioning

confidence: 99%

“…In preterm and term neonates, however, small vessels are, on average, 8.4 μm; moreover, in term neonates, the capillary diameter does not exceed 10 μm [47]. Thus, in pediatric studies, a general cutoff value of 10 μm is used [48, 49, 70–74]. Ideally, multiple measurements should be performed per organ in at least three different sites [69].…”

Section: Introductionmentioning

confidence: 99%

“…In septic pediatric patients, a persistently altered MC was prognostic for mortality and was demonstrated to be superior to the severity of the illness score using the pediatric risk of mortality 2 score in the prediction of mortality [48]. Buijs et al [49] reported poor outcomes in pediatric patients with early buccal microcirculatory impairment during therapeutic hypothermia following cardiac arrest. Re-warming improved the impaired MC to control values; however, the functional capillary density of the vessels with a diameter of 11–100 μm and the microvascular flow index before the initiation of therapeutic hypothermia were significantly decreased in non-survivors [49].…”

Section: Introductionmentioning

confidence: 99%

“…Buijs et al [49] reported poor outcomes in pediatric patients with early buccal microcirculatory impairment during therapeutic hypothermia following cardiac arrest. Re-warming improved the impaired MC to control values; however, the functional capillary density of the vessels with a diameter of 11–100 μm and the microvascular flow index before the initiation of therapeutic hypothermia were significantly decreased in non-survivors [49]. Coherence between the systemic circulation and the MC is lost when improvements in systemic parameters are not reflected by improvements in the MC [1].…”

Section: Introductionmentioning

confidence: 99%

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The vulnerable microcirculation in the critically ill pediatric patient

2016

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In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients. Therefore, the development of non-invasive methods for monitoring the MC is necessary in pediatric critical care for early identification of impending deterioration and to enable the initiation and titration of therapy to ensure cell survival. To date, the MC may be non-invasively monitored at the bedside using hand-held videomicroscopy, which provides useful information regarding the microcirculation. There is an increasing number of studies on the MC in neonates and pediatric patients; however, additional steps are necessary to transition MC monitoring from bench to bedside. The recently introduced concept of hemodynamic coherence describes the relationship between changes in the MC and macrocirculation. The loss of hemodynamic coherence may result in a depressed MC despite an improvement in the macrocirculation, which represents a condition associated with adverse outcomes. In the pediatric intensive care unit, the concept of hemodynamic coherence may function as a framework to develop microcirculatory measurements towards implementation in daily clinical practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The vulnerable microcirculation in the critically ill pediatric patient

2016

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“…High quality images of the sublingual microcirculation cannot be obtained in preterm infants because they are unable to cooperate. In term infants the buccal microcirculation has been the area of interest 7 . Fortunately, in preterm infants the thin skin allows transcutaneous microcirculatory imaging.…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Microcirculatory Imaging in Preterm Neonates

Elteren

Jonge

2015

JoVE

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Microcirculatory imaging (MI) is a relatively new research tool mainly used in the intensive care setting. MI provides a clear view of the smallest capillaries, arterioles and venules. The magnifying effect visualizes the flow pattern of erythrocytes through these vessels.It's non-invasive character makes it suitable to apply in (preterm) neonates, even in cardiorespiratory unstable patients. In adults and children, MI is mainly performed sublingually, but this is not possible in preterm infants as these cannot cooperate and the size of the probe is problematic. In preterm infants, MI is therefore performed transcutaneously. Their thin skin makes it possible to obtain high quality images of peripheral microcirculation.In this manuscript we will demonstrate the method of transcutaneous MI in preterm infants. We will focus on the different techniques and provide tips to optimize image quality. The highlights of software settings, safety and offline analysis are also addressed. Video LinkThe video component of this article can be found at

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