BACKGROUND: Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. METHODS: This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. RESULTS: A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h (r = -0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h (r = -0.476; P = 0.008). CONCLUSIONS: Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
BACKGROUND: Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. METHODS: This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. RESULTS: A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h (r = -0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h (r = -0.476; P = 0.008). CONCLUSIONS: Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
Authors: John C Greenwood; David H Jang; Stephen D Hallisey; Jacob T Gutsche; Jiri Horak; Michael A Acker; Christian A Bermudez; Victoria L Zhou; Shampa Chatterjee; Frances S Shofer; Todd J Kilbaugh; John G T Augoustides; Nuala J Meyer; Jan Bakker; Benjamin S Abella Journal: J Cardiothorac Vasc Anesth Date: 2020-05-14 Impact factor: 2.628
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