Mikrozirkulatorisches Monitoring der Sepsis

Abstract

Microcirculatory dysfunctions play a central role in the pathophysiology of sepsis and shock. Modern methods enable microvascular monitoring in man and offer the possibility to test the effect of novel therapeutical strategies for sepsis. Furthermore, these techniques may be future tools for the monitoring of critically ill patients. In this review, we will describe four microvascular monitoring devices and give an overview of the microcirculatory changes observed during the course of sepsis. Laser Doppler fluxmetry is an easy to use noninvasive technique to measure tissue perfusion enabling monitoring of the effect of different catecholamines on the gastric perfusion during sepsis. Increased microvascular permeability and altered blood flow in septic patients can be quantified by venous congestion plethysmography. Alterations in sublingual microvascular blood flow are detected by intravital microscopy in septic patients and were identified as an outcome predictor. Furthermore, the role of gastrointestinal pCO2-tonometry for microcirculatory monitoring of the perfusion of splanchnic organs during sepsis is discussed. The true clinical value of these techniques has yet to be established and will depend on larger clinical trials showing an impact on diagnostics and patient management.

Impaired Microvascular Perfusion Improves With Increased Incubator Temperature in Preterm Infants

“…Microcirculatory parameters were determined with a combined red and near-infrared emission and detection system that has been described previously in detail (7,16). In brief, the volume pulse signal is obtained using a red and near-infrared light source emitting 840 nm and 640 nm light with a sample rate of 128 Hz.…”

“…The data were continuously recorded for 5-10 min before and after the intervention. The signals are analyzed offline and signal strength parameters as AUC and the maximum of the FLUX are calculated with a custom-built software (7,17). The time sequences are measured in each volume pulse for both the RED and NIRP signal.…”

Prognostic value of intraoperative measurements of renal tissue oxygenation and microcirculation on renal function in partial nephrectomy

“…The monitoring of the microcirculation and μHbO 2 increasingly gains clinical relevance since disturbances at the level of the microcirculation are an important cornerstone of pathophysiological processes. Thus, the early detection of such disturbances becomes possible by measurements of microcirculation which are a prerequisite for timely and adequate treatment interventions [8,9].…”