Monitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions

Flick, Moritz; Duranteau, Jacques; Scheeren, Thomas; Saugel, Bernd

doi:10.1053/j.jvca.2019.10.038

Cited by 16 publications

(6 citation statements)

References 62 publications

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“…In contrast, a loss of haemodynamic coherence (i.e. decoupling) has been repeatedly reported in patients having cardiac surgery 16,26,27 and in critically ill patients with sepsis 28 . Our results support the conclusion that we can assume the haemodynamic coherence of the macrocirculation and microcirculation is intact in otherwise healthy patients presenting for elective noncardiac surgery.…”

Section: Discussionsupporting

confidence: 86%

The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy

Flick

Briesenick

Peine

et al. 2021

European Journal of Anaesthesiology

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Section: Discussionsupporting

confidence: 86%

The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy

Flick

Briesenick

Peine

et al. 2021

European Journal of Anaesthesiology

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“…Previous studies (17)(18)(19) have shown that changes in microcirculation such as decreased perfusion, functional shunting, and heterogeneous perfusion occur after CPB-assisted cardiac surgery, but there are few studies on the changes of microcirculatory parameters during the early postoperative period. A prospective observational study on microcirculatory changes in children after cardiac surgery by Scolletta et al (20) concluded that microcirculation had different trends during and after cardiac surgery in children with cyanotic heart disease and noncyanotic heart surgery.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery—a prospective cohort study

Li¹,

Tan²,

Wu³

et al. 2022

J Thorac Dis

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Background: Persistent microcirculatory dysfunction associated with increased morbidity and mortality.Interventions in the early resuscitation can be tailored to the changes of microcirculation and patient's need. However, there is usually an uncoupling of macrocirculatory and microcirculatory hemodynamics during resuscitation. Current research on the patterns of microcirculatory changes and recovery after cardiopulmonary bypass (CPB)-assisted cardiac surgery is limited. This study aimed to analyze changes in the microcirculatory parameters after CPB and their correlation with macrocirculation and to explore the characteristics of microcirculatory changes following CPB-assisted cardiac surgery.Methods: Between December 2018 and January 2019, 24 adult patients with indwelling pulmonary artery catheters after elective cardiac surgery using CPB were enrolled in this study. Both microcirculatory and macrocirculatory parameters were collected at 0, 6, 16, and 24 hours after admission to the intensive care unit (ICU). Video images of sublingual microcirculation were analyzed to obtain the microcirculatory parameters, including total vascular density (TVD), perfused small vessel density (PSVD), the proportion of perfused small vessels (PPV), microvascular flow index (MFI), and flow heterogeneity index (HI). The characteristics of microcirculatory parameter change following cardiac surgery and the correlation between microcirculatory parameters and macroscopic hemodynamic indicators, oxygen metabolic indicators, and carbon dioxide partial pressure difference (PCO 2 gap) were analyzed.Results: There were significant differences in the changes of TVD (P=0.012) and PSVD (P=0.005) during the first 24 hours postoperatively in patients who underwent CPB-assisted cardiac surgery. The microcirculatory density parameters (TVD: r=−0.5059, P=0.0456; PVD: r=−0.5499, P=0.0273) were correlated with oxygen delivery index (DO 2 I) at 24 hours after surgery. The microcirculatory flow parameters (PPV: r=0.4370, P=0.0327; MFI: r=0.6496, P=0.0006; and HI: r=−0.5350, P=0.0071) had a strong correlation with PCO 2 gap at 0 hour after surgery.Conclusions: TVD and PSVD might be two most sensitive indicators affected by CPB-assisted cardiac surgery. There was no consistency between microcirculation and macrocirculation until 24 hours following cardiac surgery, meaning the improvement of systemic hemodynamic indicators does not guarantee correspondently improvement in microcirculation. Early controlled oxygen supply after CPB-assisted cardiac surgery may be conducive to the resuscitation of patients to a certain extent.

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“…Microcirculation is generally defined as a complex network of microvessels (usually with a diameter of < 20 μm) consisting of capillaries, arterioles, and venules [ 11 ]. Sublingual microscopy enables direct inspection and evaluation of the microvascular network at the bedside [ 12 ].…”

Section: Evaluation Of Microcirculationmentioning

confidence: 99%

Microcirculation during surgery

Nam

Jeon

2022

Anesth Pain Med

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Throughout the long history of surgery, there has been great advancement in the hemodynamic management of surgical patients. Traditionally, hemodynamic management has focused on macrocirculatory monitoring and intervention to maintain appropriate oxygen delivery. However, even after optimization of macro-hemodynamic parameters, microcirculatory dysfunction, which is related to higher postoperative complications, occurs in some patients. Although the clinical significance of microcirculatory dysfunction has been well reported, little is known about interventions to recover microcirculation and prevent microcirculatory dysfunction. This may be at least partly caused by the fact that the feasibility of monitoring tools to evaluate microcirculation is still insufficient for use in routine clinical practice. However, considering recent advancements in these research fields, with more popular use of microcirculation monitoring and more clinical trials, clinicians may better understand and manage microcirculation in surgical patients in the future. In this review, we describe currently available methods for microcirculatory evaluation. The current knowledge on the clinical relevance of microcirculatory alterations has been summarized based on previous studies in various clinical settings. In the latter part, pharmacological and clinical interventions to improve or restore microcirculation are also presented.

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Monitoring of the Sublingual Microcirculation During Cardiac Surgery: Current Knowledge and Future Directions

Cited by 16 publications

References 62 publications

The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy

The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery—a prospective cohort study

Microcirculation during surgery

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