Persistent villi hypoperfusion explains intramucosal acidosis in sheep endotoxemia*

Dubin, Arnaldo; Edul, Vanina Siham Kanoore; Pozo, Mario Omar; Murias, Tiberio Feliz; Canullán, Carlos M.; Martins, Enrique; Ferrara, Gonzalo; Canales, Héctor Saúl; Laporte, Mercedes; Bakker, Jan; İnce, Can

doi:10.1097/01.ccm.0000300083.74726.43

Cited by 108 publications

(96 citation statements)

References 55 publications

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“…Dubin et al [69] showed that fluid resuscitation was able to normalize systemic and splanchnic perfusion, as well as intestinal serosal microvascular blood flow but not ileal villi blood flow, which may explain the persistence of intramucosal acidosis in endotoxemic sheep after fluid resuscitation.…”

Section: Effects Of Iah On Tissue Perfusion and Microcirculationmentioning

confidence: 99%

Abdominal pressure and gastrointestinal function: an inseparable couple?

Blaser¹,

Malbrain²,

Regli³

2017

Anaesthesiol Intensive Ther

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Evaluating the degree of organ dysfunction is a cornerstone in distinguishing patients with critical illness from those without. However, evaluation of the gastrointestinal function in critically ill patients is not unified, and is still largely based on subjective clinical evaluation. Although intra-abdominal pressure has been proposed as a parameter to facilitate monitoring of abdominal compartment in critical illness, the interactions between intra-abdominal pressure and gastrointestinal function are poorly clarified. The aim of this current review is to describe interactions and associations between gastrointestinal dysfunction and intra-abdominal pressure from a pathophysiological and clinical point of view.

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Section: Effects Of Iah On Tissue Perfusion and Microcirculationmentioning

confidence: 99%

Abdominal pressure and gastrointestinal function: an inseparable couple?

Blaser¹,

Malbrain²,

Regli³

2017

Anaesthesiol Intensive Ther

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show abstract

“…Villi hypoperfusion, however, remained present. (12) Accordingly, Boerma et al showed a dissimilar behavior of sublingual and gut microcirculation in postoperative septic patients with intestinal ostomies. Consequently, different microcirculatory beds could behave differently.…”

Section: Editorialmentioning

confidence: 99%

Microcirculação na unidade de terapia intensiva

Dubin¹

2011

Rev. bras. ter. intensiva

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“…Several measurements can be obtained from these images (24) , including functional capillary density (density of perfused capillaries), total vessel density, and a semi-quantitative estimation of the flow patterns. Although semi-quantitative, these scores have a good reproducibility for flow estimation through different sites (12)(13)(14)(25)(26)(27) , with good agreement of flow measurements with software in experimental conditions (28) , even though the analysis may sometimes be more complex in the gut (29) . Some software for image analysis are currently available, but the technical procedure is somewhat still semiautomatic and allows only measurements of flows lower than 1 mm/sec.…”

Section: How To Evaluate Microcirculation At the Bedsidementioning

confidence: 99%

Microcirculatory assessment in daily clinical practice - not yet ready but not too far!

Salgado

Favory

Backer

2010

Einstein (São Paulo)

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Shock is characterized by an alteration in tissue perfusion that may lead to tissue hypoxia. Recent guidelines recommend aggressive and early resuscitation therapy, but mortality rate is still unacceptably high. Unfortunately, traditional clinical surrogates used to guide resuscitation therapy poorly correlate with microcirculatory blood flow, a key determinant of tissue perfusion. New techniques that directly assess microcirculatory perfusion at the bedside have emerged as a complement to traditional macrohemodynamic parameters. These techniques have been supported by several studies showing microcirculatory alterations in different clinical settings. In addition, these microcirculatory alterations are related with outcome and persist regardless of arterial pressure normalization, being a better predictor of organ dysfunction and mortality than global hemodynamic and laboratory parameters. These findings allowed the concept of "microcirculatory-goal directed therapy", which is now in its preliminary phase, as the impact of many interventions still needs to be assessed. Finally, microcirculation assessment has also been explored in other medical fields such as perioperative, systemic arterial hypertension, heart failure, and hyperviscosity syndromes. In this review, we shortly present the characteristics of microcirculation and the main determinants of capillary blood flow, and we discuss advantages and limitations of some recently available techniques to evaluate microcirculation at the bedside, and how they could be useful for the general clinician in daily practice.Keywords: Shock; Resuscitation; Microcirculation/pathophysiology; Hemodynamics/physiology; Multiple organ failure/pathophysiology; Prognosis ReSUMOO choque é caracterizado por uma alteração na perfusão tecidual que pode levar à hipóxia tecidual. Diretrizes recentes recomendam uma terapia de ressuscitação hemodinâmica precoce e agressiva nos estados de choque, mas a taxa de mortalidade ainda é inaceitavelmente alta. Os parâmetros clínicos habituais usados para orientar a terapia de reanimação correlacionam-se mal com o fluxo sanguíneo capilar, um determinante essencial da perfusão tecidual. Novas técnicas que avaliam diretamente a perfusão da microcirculação à beira do leito surgem como um complemento aos parâmetros macro-hemodinâmicos tradicionais. Estas técnicas foram testadas em vários estudos que mostraram alterações microcirculatórias em diferentes situações clínicas de choque. Além disso, estas alterações microcirculatórias estão relacionadas ao prognóstico, e persistem independentemente da normalização da pressão arterial, sendo um melhor preditor de disfunção orgânica e mortalidade do que os parâmetros hemodinâmicos globais e laboratoriais. Estes achados permitiram lançar o conceito de "terapia dirigida por parâmetros microcirculatórios", atualmente em fase preliminar, uma vez que o impacto de muitas intervenções ainda precisa ser avaliado. Finalmente, a avaliação da microcirculação também foi explorada em outras áreas que não o choq...

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Persistent villi hypoperfusion explains intramucosal acidosis in sheep endotoxemia*

Abstract: In this model of endotoxemia, fluid resuscitation corrected both serosal intestinal and sublingual microcirculation but was unable to restore intestinal mucosal perfusion. Intramucosal acidosis might be due to persistent villi hypoperfusion.

Cited by 108 publications

References 55 publications

Abdominal pressure and gastrointestinal function: an inseparable couple?

Abdominal pressure and gastrointestinal function: an inseparable couple?

Microcirculação na unidade de terapia intensiva

Microcirculatory assessment in daily clinical practice - not yet ready but not too far!

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