Prolonged hypervolemic hemodilution decreases functional capillary density of ileal mucosa in pigs revealed by sidestream dark-field imaging

Turek, Z.; Černý, V.; Parizkova, R; Samek, Jindřich; Oberreiter, Martin

doi:10.1631/jzus.b1000385

Cited by 5 publications

(5 citation statements)

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“…Our main findings were the (i) feasibility of a follow-up assessment of microcirculation using Cytocam-IDF in a post-cardiac surgery ward and (ii) the increase in the FCD during the follow-up in post-ICU cardiac surgery patients undergoing diuretic therapy. Although several studies have shown that fluid administration decreases FCD (Atasever et al 2011 , 2012 ; Turek et al 2011 ; Yuruk et al 2012 ), this is, to our knowledge, the first study demonstrating the conceivable beneficial effect of fluid de-escalation in recruiting microcirculation by increasing the FCD.…”

Section: Discussionmentioning

confidence: 60%

“…Maintenance of adequate FCD is important for organ perfusion and function (Groner et al 1999 ; Tsai et al 1995 ). Several animal and human studies have reported that hemodilution decreases the FCD (Atasever et al 2012 ; Ferrara et al 2016 ; Turek et al 2011 ). Atasever et al demonstrated a decrease in the FCD in the sublingual microcirculation as an effect of the priming solution causing hemodilution during on-pump cardiac surgery (Atasever et al 2011 ).…”

Section: Introductionmentioning

confidence: 99%

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Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase—a pilot study in post ICU cardiac surgery patients

İnce

Guerci

et al. 2018

Perioper Med

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BackgroundManagement of tissue perfusion following cardiac surgery is a challenging task where common clinical parameters do not reflect microcirculatory dysfunction. Heterogeneity in blood flow perfusion and abnormalities in capillary density characterize microcirculatory dysfunction. The restoration of a normal microcirculation may become a novel target for therapy in the future in addition to macrocirculatory parameters. The aim of this study is to determine how the sublingual microcirculatory parameters vary at the bedside in post-cardiac surgery patients which underwent diuretic therapy to correct fluid overload.MethodsIn this prospective observational pilot study, video clips of sublingual microcirculation in post-cardiac surgery patients receiving furosemide and/or spironolactone to achieve normal fluid balance were recorded using Cytocam-IDF imaging. Data was obtained on the first (T0), second (T1), and third (T2) day after the patients left the intensive care unit (ICU). Measurements were analyzed off-line to obtain the following microcirculatory parameters: total vessel density (TVD), microcirculatory flow index (MFI), proportion of perfused vessel (PPV), and perfused vessel density (PVD). Macrocirculatory parameters and body weight were also collected at these time points.ResultsNinety measurements were performed in ten post ICU cardiac surgery patients. Thirteen measurements were excluded due to quality reasons; these excluded measurements were spread across the patients and time points, and there was no loss of patients or time points. An increase in TVD was observed from T0 to T1 (20 ± 2.7 to 24 ± 3.2 mm/mm2; p = 0.0410) and from T0 to T2 (20 ± 2.7 to 26 ± 3.3 mm/mm2; p = 0.0005). An increase in PVD was present from T0 to T1 (19 ± 2.3 to 24 ± 3.5 mm/mm2; p = 0.0072) and from T0 to T2 (19 ± 2.3 to 26 ± 3.4 mm/mm2, p = 0.0008). Fluid overload was assessed through a positive cumulative fluid balance on the day of ICU discharge.ConclusionsCytocam-IDF imaging to monitor microcirculation as a daily parameter is feasible and could become a valuable tool to non-invasively assess the tissue oxygenation at the bedside. An increase in TVD and PVD (functional capillary density) indicated the recruitment of the sublingual microcirculation in patients with diuretic therapy. Future research is needed to prove the correlation between the recruitment of the sublingual microcirculation and the de-escalation phase of the fluid management.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase—a pilot study in post ICU cardiac surgery patients

İnce

Guerci

et al. 2018

Perioper Med

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“…; Turek et al. ). Unlike the neonatal skin, the skin of the adult is too thick to reliably view the subcutaneous circulation, but videomicroscopy has been used for both structural and functional assessment of dermal loops for comparisons of functional capillary density (FCD) between different groups (Treu et al.…”

Section: Discussionmentioning

confidence: 98%

Videomicroscopy as a tool for investigation of the microcirculation in the newborn

et al. 2016

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The perinatal period remains a time of significant risk of death or disability. Increasing evidence suggests that this depends on microcirculatory behavior. Sidestream dark‐field orthogonal polarized light videomicroscopy (OPS) has emerged as a useful assessment of adult microcirculation but the values derived are not delineated for the newborn. We aimed to define these parameters in well term newborn infants. Demographic details were collected prospectively on 42 healthy term neonates (n = 20 females, n = 22 males). OPS videomicroscopy (Microscan) was used to view ear conch skin microcirculation at 6, 24, and 72 h of age. Stored video was analyzed by a masked observer using proprietary software. There were no significant differences between the sexes for any structural parameters at any time point. There was a significant increase over time in small vessel perfusion in female infants only (P = 0.009). A number of 6‐ and 72‐h measurements were significantly correlated, but differed from the 24‐h values. These observations confirm the utility of the ear conch for neonatal microvascular videomicroscopy. They provide a baseline for studies into the use of OPS videomicroscopy in infants. The changes observed are comparable with previous studies of term infants using these and other microvascular techniques. It is recommended that studies for examining the mature neonatal microvascular structure be delayed until 72 h of life, but studies of the physiology of cardiovascular transition should include the 24‐h time point after delivery.

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“…LDF appears to be the most reliable method for monitoring the microcirculation in the large bowel or rectum. Other methods include sidestream dark field imaging, which is based on orthogonal polarization spectral imaging, and intestinal microdialysis [5][6][7][8][9]. Larger studies, as well as comparisons of individual methods in larger samples, have yet to be conducted.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Cumulative Fluid Balance Impact on the Stability of Gastrointestinal Tract Anastomosis

et al. 2021

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Anastomotic leakage is a serious postoperative complication following a low anterior resection of rectum. Current research in colorectal surgery focuses on searching for techniques which could minimize the risk of leakage. The main objective of this study was to evaluate the impact of cumulative fluid balance on microcirculatory changes at the anastomotic site.This experimental study used 15 domestic pigs; all of the animals underwent rectal resection. Then the animals were divided into three groups and received IV crystalloids at various rates, i.e. 5 ml/kg/h; 10 ml/kg/h; and 20 ml/kg/h. Large bowel micro-perfusion was measured using laser Doppler flowmetry during and following the surgical procedure.The experiments were successfully performed in all 15 cases. No animal died during the procedure or during the follow-up. We found no differences in micro-perfusion of the bowel between the experimental groups during the surgical procedure and during the follow-up period after the surgery. A significant decrease in micro-perfusion was observed after the transection of the inferior mesenteric artery in all the groups; again, no differences between the groups were observed.We did not confirm the original hypothesis that excessive load of IV crystalloids during the surgery would have a negative effect on bowel micro-perfusion and thus a negative effect on the healing of the anastomosis. However, laser Doppler flowmetry was found to have high accuracy in measuring tissue microcirculation and has the potential to be used in clinical practice.

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Prolonged hypervolemic hemodilution decreases functional capillary density of ileal mucosa in pigs revealed by sidestream dark-field imaging

Abstract: Prolonged HHD established by crystalloid solution significantly decreased ileal villus FCD when compared to restrictive fluid regimen. An inappropriate degree of HHD can be harmful during uncomplicated abdominal surgery.

Cited by 5 publications

References 44 publications

Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase—a pilot study in post ICU cardiac surgery patients

Recruitment of sublingual microcirculation using handheld incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase—a pilot study in post ICU cardiac surgery patients

Videomicroscopy as a tool for investigation of the microcirculation in the newborn

Analysis of Cumulative Fluid Balance Impact on the Stability of Gastrointestinal Tract Anastomosis

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