OBJECTIVES: Orthogonal polarized spectral imaging- and sidestream darkfield-technique have enabled visual evaluation of the microcirculation. Different investigators described microcirculatory alterations, especially in surgical patients suffering from septic shock. We investigated the sublingual microcirculation in non-surgical patients admitted to our medical, intensive care unit (ICU). METHODS: In 24 severely ill (APACHE-II Score: 27.8+/-11.3), intubated patients admitted to our ICU the sublingual microcirculation was recorded with a handheld intravital microscope. Sublingual vessels were categorized according to their size (small: 10-25 microm; medium: 26-50 microm; large: 51-100 microm) and the flow in semiquantitative categories (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow). RESULTS: Patients with cardiogenic shock (n=7) had lower microflow compared with patients without cardiogenic shock (small p<0.001, medium p<0.001, large p=0.003). Several other diseases, including diabetes and arterial hypertension, age, gender, had no influence. In general, patients with a flow less than 3 in the small vessels showed higher arterial blood lactate levels (p=0.043) compared to continuous flow. CONCLUSIONS: A consequence of cardiogenic shock is the impairment of microcirculation with organ hypoperfusion. We observed that cardiac output is correlated to disturbance in microflow in the smallest vessels. On-line evaluation of microcirculation in vivo may be a valid tool for optimizing therapeutic measures in high risk patients. Additional online material may be found at: http://www.kim1.uniklinik-jena.de/Microcirculation.html.
OBJECTIVES: Orthogonal polarized spectral imaging- and sidestream darkfield-technique have enabled visual evaluation of the microcirculation. Different investigators described microcirculatory alterations, especially in surgical patients suffering from septic shock. We investigated the sublingual microcirculation in non-surgical patients admitted to our medical, intensive care unit (ICU). METHODS: In 24 severely ill (APACHE-II Score: 27.8+/-11.3), intubated patients admitted to our ICU the sublingual microcirculation was recorded with a handheld intravital microscope. Sublingual vessels were categorized according to their size (small: 10-25 microm; medium: 26-50 microm; large: 51-100 microm) and the flow in semiquantitative categories (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow). RESULTS:Patients with cardiogenic shock (n=7) had lower microflow compared with patients without cardiogenic shock (small p<0.001, medium p<0.001, large p=0.003). Several other diseases, including diabetes and arterial hypertension, age, gender, had no influence. In general, patients with a flow less than 3 in the small vessels showed higher arterial blood lactate levels (p=0.043) compared to continuous flow. CONCLUSIONS: A consequence of cardiogenic shock is the impairment of microcirculation with organ hypoperfusion. We observed that cardiac output is correlated to disturbance in microflow in the smallest vessels. On-line evaluation of microcirculation in vivo may be a valid tool for optimizing therapeutic measures in high risk patients. Additional online material may be found at: http://www.kim1.uniklinik-jena.de/Microcirculation.html.
Authors: Christian Jung; Georg Fuernau; Suzanne de Waha; Ingo Eitel; Steffen Desch; Gerhard Schuler; Hans R Figulla; Holger Thiele Journal: Clin Res Cardiol Date: 2015-02-27 Impact factor: 5.460
Authors: Daniel De Backer; Gustavo Ospina-Tascon; Diamantino Salgado; Raphaël Favory; Jacques Creteur; Jean-Louis Vincent Journal: Intensive Care Med Date: 2010-08-06 Impact factor: 17.440
Authors: Christian Jung; Christoph Rödiger; Michael Fritzenwanger; Julia Schumm; Alexander Lauten; Hans R Figulla; Markus Ferrari Journal: Clin Res Cardiol Date: 2009-04-15 Impact factor: 5.460
Authors: Namkje A R Vellinga; E Christiaan Boerma; Matty Koopmans; Abele Donati; Arnaldo Dubin; Nathan I Shapiro; Rupert M Pearse; Peter H J van der Voort; Arjen M Dondorp; Tony Bafi; Michael Fries; Tulin Akarsu-Ayazoglu; Andrius Pranskunas; Steven Hollenberg; Gianmarco Balestra; Mat van Iterson; Farid Sadaka; Gary Minto; Ulku Aypar; F Javier Hurtado; Giampaolo Martinelli; Didier Payen; Frank van Haren; Anthony Holley; Hernando Gomez; Ravindra L Mehta; Alejandro H Rodriguez; Carolina Ruiz; Héctor S Canales; Jacques Duranteau; Peter E Spronk; Shaman Jhanji; Sheena Hubble; Marialuisa Chierego; Christian Jung; Daniel Martin; Carlo Sorbara; Jan Bakker; Can Ince Journal: Crit Care Date: 2017-10-18 Impact factor: 9.097