Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A Prospective Randomized Trial

Hammami, Mohamed; Hosny, Hisham; Tawadros, Pierre Zarif; Elayashy, Mohamed; El-Ashmawi, Hossam

doi:10.1053/j.jvca.2018.06.016

Cited by 13 publications

(13 citation statements)

References 35 publications

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“…Eight studies (42%) reported PPV, of which 63% [14,15,[18][19][20] showed a reduction in PPV following CPB compared to baseline pre-CPB. The other studies that reported PPV (37%) [21][22][23] reported no significant effect of CPB on PPV. Eleven studies (57%) reported PVD, of which 64% [14,15,20,[24][25][26][27] showed a significant decrease in PVD and 36% [21][22][23]28] showed no effect of CPB on PVD.…”

Section: Functional Capillary Density Perfused Vessel Density and Pmentioning

confidence: 80%

“…The other studies that reported PPV (37%) [21][22][23] reported no significant effect of CPB on PPV. Eleven studies (57%) reported PVD, of which 64% [14,15,20,[24][25][26][27] showed a significant decrease in PVD and 36% [21][22][23]28] showed no effect of CPB on PVD. In total, 17 out of 19 studies reported FCD, PPV or PVD and 77% of these studies showed a decrease in one or more of these microcirculatory perfusion parameters during cardiac surgery with CPB.…”

Section: Functional Capillary Density Perfused Vessel Density and Pmentioning

confidence: 80%

“…Finally, 64 full texts were examined and 45 were excluded based on conference abstracts (n = 20), absence of CPB (n = 4), absence of microcirculatory perfusion measurement (n = 5), missing pre-operative measurement (n = 11), and reviews (n = 5). Finally, 19 studies were included that recorded perioperative measurements of sublingual microcirculatory perfusion parameters in adult patients undergoing cardiac surgery with CPB [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 9 out of 19 studies (47%) reported the MFI. Three studies showed a significant decrease in MFI compared to baseline after initiation of CPB during cardiac surgery [22,24,29]. In contrast, two studies observed an increase in MFI compared to baseline after initiation of CPB during surgery [20,23].…”

Section: Microvascular Flow Indexmentioning

confidence: 96%

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Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

Brom

Leeuwen

et al. 2020

Crit Care

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Background: Microcirculatory perfusion disturbances are associated with increased morbidity and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Technological advancements made it possible to monitor sublingual microcirculatory perfusion over time. The goal of this review is to provide an overview of the course of alterations in sublingual microcirculatory perfusion following CPB. The secondary goal is to identify which parameter of sublingual microcirculatory perfusion is most profoundly affected by CPB. Methods: PubMed and Embase databases were systematically searched according to PRISMA guidelines and as registered in PROSPERO. Studies that reported sublingual microcirculatory perfusion measurements before and after onset of CPB in adult patients undergoing cardiac surgery were included. The primary outcome was sublingual microcirculatory perfusion, represented by functional capillary density (FCD), perfused vessel density (PVD), total vessel density (TVD), proportion of perfused vessels (PPV), and microvascular flow index (MFI). Results: The search identified 277 studies, of which 19 fulfilled all eligibility criteria. Initiation of CPB had a profound effect on FCD, PVD, or PPV. Seventeen studies (89%) reported one or more of these parameters, and in 11 of those studies (65%), there was a significant decrease in these parameters during cardiac surgery; the other 6 studies (35%) reported no effect. In 29% of the studies, FCD, PVD, or PPV normalized by the end of cardiac surgery, and in 24% percent of the studies, this effect lasted at least 24 h. There was no clear effect of CPB on TVD and a mixed effect on MFI. Conclusion: CPB during cardiac surgery impaired sublingual microcirculatory perfusion as reflected by reduced FCD, PVD, and PPV. Four studies reported this effect at least 24 h after surgery. Further research is warranted to conclude on the duration of CPB-induced microcirculatory perfusion disturbances and the relationship with clinical outcome.

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Section: Functional Capillary Density Perfused Vessel Density and Pmentioning

confidence: 80%

Section: Functional Capillary Density Perfused Vessel Density and Pmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Microvascular Flow Indexmentioning

confidence: 96%

See 2 more Smart Citations

Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

Brom

Leeuwen

et al. 2020

Crit Care

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“…Although there are no techniques to monitor the microcirculation in widespread clinical use, a number of modalities have recently been examined. In particular, novel handheld microscopes [ 10 ] have been used to visualise the sublingual microcirculation in critical illness (e.g., sepsis, high-risk surgery) [ 11 ] and also to study the effects of pharmacological therapies targeting the microcirculation [ 12 ]. The retinal vasculature is an established non-invasive proxy of systemic microvascular health.…”

Section: Introductionmentioning

confidence: 99%

The Eye as a Non-Invasive Window to the Microcirculation in Liver Cirrhosis: A Prospective Pilot Study

Gifford

Moroni

Farrah

et al. 2020

JCM

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Microcirculatory dysfunction is associated with organ failure, poor response to vasoactive drugs and increased mortality in cirrhosis, but monitoring techniques are not established. We hypothesized that the chorioretinal structures of the eye could be visualized as a non-invasive proxy of the systemic microvasculature in cirrhosis and would correlate with renal dysfunction. Optical Coherence Tomography (OCT) was performed to image the retina in n = 55 cirrhosis patients being assessed for liver transplantation. OCT parameters were compared with established cohorts of age- and sex-matched healthy volunteers (HV) and patients with chronic kidney disease (CKD). Retinal thickness, macular volume and choroidal thickness were significantly reduced relative to HV and comparable to CKD patients (macular volume: HV vs. cirrhosis mean difference 0.44 mm3 (95% CI 0.26–0.61), p ≤ 0.0001). Reduced retinal thickness and macular volume correlated with renal dysfunction in cirrhosis (macular volume vs. MDRD-6 eGFR r = 0.40, p = 0.006). Retinal changes had resolved substantially 6 weeks following transplantation. There was an inverse association between choroidal thickness and circulating markers of endothelial dysfunction (endothelin-1 r = −0.49, p ≤ 0.001; von Willebrand factor r = −0.32, p ≤ 0.05). Retinal OCT may represent a non-invasive window to the microcirculation in cirrhosis and a dynamic measure of renal and endothelial dysfunction. Validation in different cirrhosis populations is now required.

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The microcirculation in perioperative medicine: a narrative review

Flick,

Hilty,

Duranteau

et al. 2024

British Journal of Anaesthesia

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Effect of Dexmedetomidine Infusion on Sublingual Microcirculation in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery: A Prospective Randomized Trial

Cited by 13 publications

References 35 publications

Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review

The Eye as a Non-Invasive Window to the Microcirculation in Liver Cirrhosis: A Prospective Pilot Study

The microcirculation in perioperative medicine: a narrative review

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