International Study on Microcirculatory Shock Occurrence in Acutely Ill Patients*

Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M; Machado, Flávia Ribeiro; Fries, Michael; Akarsu-Ayazoglu, Tulin; Pranskūnas, Andrius; Hollenberg, Steven M.; Balestra, G; Iterson, Mat van; Voort, Peter H. J. van der; Sadaka, Farid; Minto, Gary; Aypar, Ülkü; Hurtado, Francisco Javier; Martinelli, Giampaolo; Payen, Didier; Haren, Frank van; Holley, Anthony; Pattnaik, Rajyabardhan; Gómez, Hernando; Mehta, Ravindra L.; Rodríguez, Alejandro; Ruíz, Carolina; Canales, Héctor Saúl; Duranteau, Jacques; Spronk, Peter E.; Jhanji, Shaman; Hubble, Sheena; Chierego, Marialuisa; Jung, Christian; Martin, Daniel S.; Sorbara, Carlo; Tijssen, Jan G.P.; Bakker, Jan; İnce, Can

doi:10.1097/ccm.0000000000000553

Cited by 130 publications

(106 citation statements)

References 60 publications

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“…Thus, oral microcirculation is not an indicator of gastrointestinal microcirculation and organ function per se, especially if flow only is analyzed, without an assessment of oxygenation. This might explain the results of the recently published international study on microcirculatory shock occurrence in acutely ill patients (microSOAP) [32]. The study found a 17% prevalence of abnormal capillary microvascular flow index among 501 patients.…”

Section: Discussionsupporting

confidence: 71%

Effect of Topical Iloprost and Nitroglycerin on Gastric Microcirculation and Barrier Function during Hemorrhagic Shock in Dogs

et al. 2017

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Background: Topical drug application is used to avoid systemic side effects. The aim of this study was to analyze whether locally applied iloprost or nitroglycerin influence gastric mucosal perfusion, oxygenation, and barrier function during physiological and hemorrhagic conditions. Methods: In repeated experiments, 5 anesthetized dogs received iloprost, nitroglycerin, or normal saline during physiological and hemorrhagic (-20% blood volume) conditions. Macro- and microcirculatory variables were recorded continuously. Gastric barrier function was assessed via translocation of sucrose into the blood. Results: During hemorrhage, gastric mucosal oxygenation decreased from 77 ± 4 to 37 ± 7%. This effect was attenuated by nitroglycerin (78 ± 6 to 47 ± 13%) and iloprost (82 ± 4 to 54 ± 9%). Sucrose plasma levels increased during hemorrhage from 7 ± 4 to 55 ± 15 relative amounts. This was alleviated by nitroglycerin (5 ± 8 to 29 ± 38 relative amounts). These effects were independent of systemic hemodynamic variables. Conclusions: During hemorrhage, topical nitroglycerin and iloprost improve regional gastric oxygenation without affecting perfusion. Nitroglycerin attenuated the shock-induced impairment of the mucosal barrier integrity. Thus, local drug application improves gastric microcirculation without compromising systemic hemodynamic variables, and it may also protect mucosal barrier function.

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Section: Discussionsupporting

confidence: 71%

Effect of Topical Iloprost and Nitroglycerin on Gastric Microcirculation and Barrier Function during Hemorrhagic Shock in Dogs

et al. 2017

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“…Since the landmark paper by De Backer et al [1], numerous studies have addressed microcirculatory dysfunction in septic shock, established its pathophysiological relevance, and demonstrated the prognostic impact of persistent abnormalities [2][3][4][5]. Sublingual microcirculation, which is easy to access with video-microscopic techniques, is the most frequently explored territory in humans.…”

Section: Introductionmentioning

confidence: 99%

Is the macrocirculation really dissociated from the microcirculation in septic shock?

Hernández

Teboul

2016

Intensive Care Med

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“…In recent years, several direct microcirculation monitoring techniques have also been devised [57]. Although initial studies have shown some correlation between mortality and the direct microcirculation measurement in early ICU admissions (≤48 h) [58,59,60], the results have not been consistent, especially in heterogeneous ICU patients [61]. Moreover, in their current state, the methods require cumbersome offline data analysis, not yet feasible for routine bedside use.…”

Section: Fluid Requirement In Healthy and In Hospitalized Patientsmentioning

confidence: 99%

Intravenous Fluids and Acute Kidney Injury

2017

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Over 50% of the human body is comprised of fluids that are distributed in defined compartments. Although compartmentalized, these fluids are dynamically connected. Fluids, electrolytes, and acid-base balance in each compartment are tightly regulated, mostly in an energy-dependent manner to achieve their designed functions. For over a century, our understanding of the microvascular fluid homeostasis has evolved from hypothesized Ernest Starling principle to evidence-based and the revised Starling principle, incorporating the functional endothelial surface layer. The kidney is a highly vascular and encapsulated organ that is exquisitely sensitive to inadequate (insufficient or excess) blood flow. The kidney is particularly sensitive to venous congestion, and studies show that reduced venous return triggers a greater degree of kidney damage than that from lacking arterial flow. Thus, fluid overload can induce severe and sustained kidney injury. In the setting of established acute kidney injury, fluid management can be challenging. Impaired capacity of urine output and urine concentration and dilution should be taken into consideration when designing fluid therapy. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452702.

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International Study on Microcirculatory Shock Occurrence in Acutely Ill Patients*

Abstract: In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.

Cited by 130 publications

References 60 publications

Effect of Topical Iloprost and Nitroglycerin on Gastric Microcirculation and Barrier Function during Hemorrhagic Shock in Dogs

Effect of Topical Iloprost and Nitroglycerin on Gastric Microcirculation and Barrier Function during Hemorrhagic Shock in Dogs

Is the macrocirculation really dissociated from the microcirculation in septic shock?

Intravenous Fluids and Acute Kidney Injury

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