Sublingual microcirculatory changes during transient intra-abdominal hypertension – A prospective observational study in laparoscopic surgery patients

Abstract

BACKGROUND: Microvascular alterations and intra-abdominal hypertension are both involved in development of organ failure. It is not known whether increased intra-abdominal pressure (IAP) is associated with microcirculatory perfusion derangements. HYPOTHESIS: Transient increase in IAP induced by pneumoperitoneum affects sublingual microcirculation. METHODS: 16 laparoscopic cholecystectomy patients were studied. Sidestream dark field (SDF) imaging was used to evaluate sublingual microcirculation. Microcirculatory videos were done before surgery, at least 15 minutes after initiation of pneumoperitoneum and 1 hour after the pneumoperitoneum. Microcirculation cut-off value for vessels was 20 m. RESULTS: IAP was held at 12.6 (from 12 to 14) mmHg, mean (SD) duration of pneumoperitoneum was 41 (14) minutes. At the baseline, mean total vascular density was 18.8 (2.6) and perfused vessel density 13.2 (2.9) per mm 2 . Proportion of perfused vessels was 59 (11) % and microvascular flow index 2.2 (0.4). Median (IQR) heterogeneity index was 0.6 (0.4-0.9) and mean De Backer score 13.6 (1.5). Increase in IAP did not cause significant changes in sublingual microcirculatory parameters. CONCLUSIONS: Transiently increased IAP due to pneumoperitoneum does not affect sublingual microcirculatory blood flow and vessel density in patients undergoing laparoscopic surgery. However, the low proportion of perfused vessels indicates the prevalence of perioperative microcirculatory deficiency in these patients.

Effects of High Volume Haemodiafiltration on Inflammatory Response Profile and Microcirculation in Patients with Septic Shock

“…We did not find any changes in sublingual microcirculatory parameters. The patients were volume resuscitated before the study inclusion and had microcirculation indices close to normal [ 27 ]. While the increase on blood pressure during HVHF occurs due to increased vascular resistance rather than increased cardiac output [ 8 ], disturbances of microcirculation might be aggravated [ 28 ].…”

Hemorheological factors can be informative in comparing treatment possibilities of abdominal compartment syndrome

“…Abdominal compartment syndrome is defined as a sustained IAP over 20 mmHg (IAH grade III-IV), when the abdominal perfusion pressure decreases and the intra-abdominal hypertension is associated with any organ dysfunction [15,24]. In development of organ dysfunction besides the decreased perfusion pressure and hemodynamical alterations, supposedly hemorheological and microcirculatory deterioration also might play a role [3,14,20].…”