Microcirculation-guided protection strategy in hemodynamic therapy

Pan, Pan; Su, Longxiang; Liu, Dawei; Wang, Xiaoting

doi:10.3233/ch-190784

Cited by 10 publications

(11 citation statements)

References 74 publications

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“…As far as we know, the current treatment for distributive shock ensures blood perfusion of macrocirculation. Precise treatment of the microvascular hypoperfusion is difficult ( Vincent and De Backer, 2013 ; Pan et al, 2020 ). The development of various techniques has provided new ideas for the treatment of the microvascular hypoperfusion ( Galanzha et al, 2009 ; Lenshof et al, 2009 ; Galanzha et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Distributive shock is a condition defined by the presence of the microvascular hypoperfusion despite the normalization of systemic and regional blood flow ( Vincent and De Backer, 2013 ). In this case, fatal results will be caused when the oxygen delivery does not meet the metabolic needs of the tissue in vital organs ( Pan et al, 2020 ). In order to keep the blood flowing in the microvessel and thus improve the oxygen delivery, several treatments such as fluid resuscitation, vasoactive drugs, positive inotropic drugs, obstruction relief, and mechanical assistance are commonly used ( Legrand et al, 2018 ; Boros and Bauer, 2021 ; Jha et al, 2021 ; Jiang et al, 2021 ; Motwani and Saunders, 2021 ; Scheeren et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Non-Invasive Dynamic Reperfusion of Microvessels In Vivo Controlled by Optical Tweezers

Meng

Zhong

Wang

et al. 2022

Front. Bioeng. Biotechnol.

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Distributive shock is considered to be a condition of microvascular hypoperfusion, which can be fatal in severe cases. However, traditional therapeutic methods to restore the macro blood flow are difficult to accurately control the blood perfusion of microvessels, and the currently developed manipulation techniques are inevitably incompatible with biological systems. In our approach, infrared optical tweezers are used to dynamically control the microvascular reperfusion within subdermal capillaries in the pinna of mice. Furthermore, we estimate the effect of different optical trap positions on reperfusion at branch and investigate the effect of the laser power on reperfusion. The results demonstrate the ability of optical tweezers to control microvascular reperfusion. This strategy allows near-noninvasive reperfusion of the microvascular hypoperfusion in vivo. Hence, our work is expected to provide unprecedented insights into the treatment of distributive shock.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-Invasive Dynamic Reperfusion of Microvessels In Vivo Controlled by Optical Tweezers

Meng

Zhong

Wang

et al. 2022

Front. Bioeng. Biotechnol.

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“…Therefore, even if the prediction of postoperative outcomes is possible at early stages, there is currently a limit to improving the postoperative outcomes. Rather, accurate hemodynamic therapy for microcirculation protection, including precise fluid resuscitation and adjustment of organ perfusion pressure should be applied [ 35 ]. Importantly, they must be guided by microcirculatory monitoring, such as NIRS, side-stream or incident dark-field imaging, or peripheral perfusion index [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery

Cho

Lee

Hong

et al. 2022

Korean J Anesthesiol

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Background: Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery.Methods: This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope.Results: Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%.Conclusions: Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.

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“…[ 1 ] However, macrovascular parameters cannot indicate what is occurring at the microvascular level under pathological conditions. [ 1 , 2 ] The degradation and shedding of the endothelial glycocalyx have been proposed as a mechanism that contributes to a poor prognosis in critically ill patients. [ 3 ] The endothelial glycocalyx is a layer that lines the luminal side of the endothelium and regulates vascular permeability, microcirculation perfusion, and leukocyte adhesion on the endothelium.…”

Section: Introductionmentioning

confidence: 99%

Resuscitation fluids as drugs: targeting the endothelial glycocalyx

Wang

Zhang²,

Liu³

et al. 2022

Chinese Medical Journal

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Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

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Microcirculation-guided protection strategy in hemodynamic therapy

Cited by 10 publications

References 74 publications

Non-Invasive Dynamic Reperfusion of Microvessels In Vivo Controlled by Optical Tweezers

Non-Invasive Dynamic Reperfusion of Microvessels In Vivo Controlled by Optical Tweezers

Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery

Resuscitation fluids as drugs: targeting the endothelial glycocalyx

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