Michele Diana1,2,3, Eric Noll4,5, Anne-Laure Charles5, Pierre Diemunsch4,5, Bernard Geny5, Yu-Yin Liu6,7, Francesco Marchegiani6, Luigi Schiraldi6, Vincent Agnus6, Veronique Lindner8, Lee Swanström9, Bernard Dallemagne6, Jacques Marescaux9,6. 1. IHU-Strasbourg, Institute for Minimally Invasive Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, France. michele.diana@ircad.fr. 2. EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France. michele.diana@ircad.fr. 3. Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France. michele.diana@ircad.fr. 4. Department of Anesthesiology, University Hospital of Strasbourg, Strasbourg, France. 5. EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France. 6. Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France. 7. Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan. 8. Pathology Department, University Hospital of Strasbourg, Strasbourg, France. 9. IHU-Strasbourg, Institute for Minimally Invasive Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, France.
Abstract
BACKGROUND AND AIMS: Confocal laser endomicroscopy (CLE) can provide real-time evaluation of bowel perfusion. We aimed to evaluate CLE perfusion imaging in a hemorrhagic shock model. MATERIALS AND METHODS: Five pigs were equipped to ensure hemodynamic monitoring. Three ileostomies per animal (total n = 15) were randomly created (T0). Blood was withdrawn targeting a mean arterial pressure of 40 mmHg (shock phase, T1), for 90 min. Infusion of Ringer's lactate was started and continued for 90 min (T2). At the different time points: (a) stomas' mucosa was scanned with CLE; (b) capillary lactates were measured on blood obtained by puncturing stomas' mucosa; and (c) full-thickness stomas' biopsies were sampled for histology, mitochondrial respiratory rate (V 0 = basal and V ADP = respiratory rate in excess of adenosine diphosphate), and levels of superoxide anion evaluation. Functional capillary density (FCD) was measured using ad hoc software. RESULTS: Confocal scanning provided consistent and specific imaging of bowel hypoperfusion at T1: vascular hyperpermeability (blurred and enlarged capillaries) and edema (enhanced visualization of the brush border due to increased intercellular spaces and fluorescein leakage). At the end of T2, there was an improved capillary flow. FCD-A index expressed statistically significant correlation with (1) stoma capillary lactates (p = 0.023); (2) systemic capillary lactates (p = 0.031); (3) inflammation pathology score (p = 0.048); (4) central venous pressure (p = 0.0043); and (5) pulmonary artery pressure (p = 0.01). Stoma capillary lactates (mmol/L) were significantly increased at T1 (8.81 ± 4.23; p < 0.0001) and at T2 (4.77 ± 3.13; p < 0.01) when compared to T0 inclusion values (1.86 ± 0.56). V 0 and V ADP (pmol O2/min/mg tissue) were both significantly decreased at T1 versus T0 (p < 0.007 and p < 0.01, respectively) and recovered by the end of reanimation (T2 vs. T0, p = n.s.). Mean O 2·- production (µmol/min/mg/dry tissue) increased at T1 and significantly decreased at T2. CONCLUSIONS: Confocal laser endomicroscopy (CLE) imaging could identify morphological signs congruent with biochemical markers of bowel perfusion and could be useful for assessment of stomas.
BACKGROUND AND AIMS: Confocal laser endomicroscopy (CLE) can provide real-time evaluation of bowel perfusion. We aimed to evaluate CLE perfusion imaging in a hemorrhagic shock model. MATERIALS AND METHODS: Five pigs were equipped to ensure hemodynamic monitoring. Three ileostomies per animal (total n = 15) were randomly created (T0). Blood was withdrawn targeting a mean arterial pressure of 40 mmHg (shock phase, T1), for 90 min. Infusion of Ringer's lactate was started and continued for 90 min (T2). At the different time points: (a) stomas' mucosa was scanned with CLE; (b) capillary lactates were measured on blood obtained by puncturing stomas' mucosa; and (c) full-thickness stomas' biopsies were sampled for histology, mitochondrial respiratory rate (V 0 = basal and V ADP = respiratory rate in excess of adenosine diphosphate), and levels of superoxide anion evaluation. Functional capillary density (FCD) was measured using ad hoc software. RESULTS: Confocal scanning provided consistent and specific imaging of bowel hypoperfusion at T1: vascular hyperpermeability (blurred and enlarged capillaries) and edema (enhanced visualization of the brush border due to increased intercellular spaces and fluorescein leakage). At the end of T2, there was an improved capillary flow. FCD-A index expressed statistically significant correlation with (1) stoma capillary lactates (p = 0.023); (2) systemic capillary lactates (p = 0.031); (3) inflammation pathology score (p = 0.048); (4) central venous pressure (p = 0.0043); and (5) pulmonary artery pressure (p = 0.01). Stoma capillary lactates (mmol/L) were significantly increased at T1 (8.81 ± 4.23; p < 0.0001) and at T2 (4.77 ± 3.13; p < 0.01) when compared to T0 inclusion values (1.86 ± 0.56). V 0 and V ADP (pmol O2/min/mg tissue) were both significantly decreased at T1 versus T0 (p < 0.007 and p < 0.01, respectively) and recovered by the end of reanimation (T2 vs. T0, p = n.s.). Mean O 2·- production (µmol/min/mg/dry tissue) increased at T1 and significantly decreased at T2. CONCLUSIONS: Confocal laser endomicroscopy (CLE) imaging could identify morphological signs congruent with biochemical markers of bowel perfusion and could be useful for assessment of stomas.
Authors: A I Schlagowski; F Singh; A L Charles; T Gali Ramamoorthy; F Favret; F Piquard; B Geny; J Zoll Journal: J Appl Physiol (1985) Date: 2013-12-12
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Authors: Michele Diana; Eric Noll; Andras Legnèr; Seong-Ho Kong; Yu-Yin Liu; Luigi Schiraldi; Francesco Marchegiani; Jordan Bano; Bernard Geny; Anne-Laure Charles; Bernard Dallemagne; Véronique Lindner; Didier Mutter; Pierre Diemunsch; Jacques Marescaux Journal: Surg Endosc Date: 2018-01-12 Impact factor: 4.584