Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 5/2012

01-10-2012 | INVITED REVIEW

Monitoring the microcirculation

Authors: Daniel De Backer, Katia Donadello, Diego Orbegozo Cortes

Published in: Journal of Clinical Monitoring and Computing | Issue 5/2012

Login to get access

Abstract

One of the main goals of hemodynamic support is to preserve tissue perfusion. However issue perfusion is related more to microvascular perfusion than aortic blood flow. Monitoring the microcirculation has long been difficult. Recent technologic advances have made feasible monitoring of the microcirculation at bedside of critically ill patients. In this review, we will discuss the relevance of the various tools available to monitor the microcirculation. Videomicroscopic devices such as sidestream darkfield imaging are the most appropriate techniques to evaluate the microcirculation, taking into account the heterogeneous aspect of diseased microcirculation, as in sepsis. The microcirculation can also be indirectly assessed by measuring tissue PCO2. Transcutaneous PCO2 measurement at ear lobe is particularly promising. Finally, near infrared spectroscopy can also provide interesting information, especially using vascular occlusion tests which reactivity of the microcirculation to a transient hypoxic insult. These different devices have provided important data helping us to better understand the pathophysiology of sepsis and multiple organ failure.
Literature
1.
De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98–104.PubMedCrossRef
2.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147:91–9.PubMedCrossRef
3.
Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistant microvasculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32:1825–31.PubMedCrossRef
4.
den Uil CA, Lagrand WK, van der EM, Jewbali LS, Cheng JM, Spronk PE, Simoons ML. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2010;31:3032–9.CrossRef
5.
Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Buchele G, Simion D, Chierego M, Oliveira Silva T, Fonseca A, Vincent JL, De Backer D. Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med. 2010;36:949–55.PubMedCrossRef
6.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34:403–8.PubMedCrossRef
7.
Morelli A, Donati A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, Landoni G, Pelaia P, Pietropaoli P, Van Aken H, Teboul JL, Ince C, Westphal M. Levosimendan for resuscitating the microcirculation in patients with septic shock: a randomized controlled study. Crit Care. 2010;14:R232.PubMedCrossRef
8.
Edul VS, Enrico C, Laviolle B, Vazquez AR, Ince C, Dubin A. Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med. 2012;40:1443–8.PubMedCrossRef
9.
Eipel C, Bordel R, Nickels RM, Menger MD, Vollmar B. Impact of leukocytes and platelets in mediating hepatocyte apoptosis in a rat model of systemic endotoxemia. Am J Physiol Gastrointest Liver Physiol. 2004;286:G769–76.PubMedCrossRef
10.
Kao R, Xenocostas A, Rui T, Yu P, Huang W, Rose J, Martin CM. Erythropoietin improves skeletal muscle microcirculation and tissue bioenergetics in a mouse sepsis model. Crit Care. 2007;11:R58.PubMedCrossRef
11.
Doerschug KC, Delsing AS, Schmidt GA, Haynes WG. Impairments in microvascular reactivity are related to organ failure in human sepsis. Am J Physiol Heart Circ Physiol. 2007;293:H1065–71.PubMedCrossRef
12.
Shapiro NI, Arnold R, Sherwin R, O’Connor J, Najarro G, Singh S, Lundy D, Nelson T, Trzeciak SW, Jones AE. The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis. Crit Care. 2011;15:R223.PubMedCrossRef
13.
Trzeciak S, McCoy JV, Phillip DR, Arnold RC, Rizzuto M, Abate NL, Shapiro NI, Parrillo JE, Hollenberg SM. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med. 2008;34:2210–7.PubMedCrossRef
14.
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL. The prognostic value of muscle StO(2) in septic patients. Intensive Care Med. 2007;33:1549–56.PubMedCrossRef
15.
Top AP, Ince C, de Meij N, van Dijk M, Tibboel D. Persistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care. Crit Care Med. 2011;39:8–13.PubMedCrossRef
16.
De Backer D, Donadello K, Taccone FS, Ospina-Tascon G, Salgado D, Vincent JL. Microcirculatory alterations: potential mechanisms and implications for therapy. Ann Intensive Care. 2011;1:27.PubMedCrossRef
17.
Tyml K, Wang X, Lidington D, Ouellette Y. Lipopolysaccharide reduces intercellular coupling in vitro and arteriolar conducted response in vivo. Am J Physiol Heart Circ Physiol. 2001;281:H1397–406.PubMed
18.
Drost EM, Kassabian G, Meiselman HJ, Gelmont D, Fisher TC. Increased rigidity and priming of polymorphonuclear leukocytes in sepsis. Am J Respir Crit Care Med. 1999;159:1696–702.PubMed
19.
Astiz ME, DeGent GE, Lin RY, Rackow EC. Microvascular function and rheologic changes in hyperdynamic sepsis. Crit Care Med. 1995;23:265–71.PubMedCrossRef
20.
Kirschenbaum LA, Astiz ME, Rackow EC, Saha DC, Lin R. Microvascular response in patients with cardiogenic shock. Crit Care Med. 2000;28:1290–4.PubMedCrossRef
21.
Eichelbronner O, Sielenkamper A, Cepinskas G, Sibbald WJ, Chin-Yee IH. Endotoxin promotes adhesion of human erythrocytes to human vascular endothelial cells under conditions of flow. Crit Care Med. 2000;28:1865–70.PubMedCrossRef
22.
Nieuwdorp M, Mooij HL, Kroon J, Atasever B, Spaan JA, Ince C, Holleman F, Diamant M, Heine RJ, Hoekstra JB, Kastelein JJ, Stroes ES, Vink H. Endothelial glycocalyx damage coincides with microalbuminuria in type 1 diabetes. Diabetes. 2006;55:1127–32.PubMedCrossRef
23.
Marechal X, Favory R, Joulin O, Montaigne D, Hassoun S, Decoster B, Zerimech F, Neviere R. Endothelial glycocalyx damage during endotoxemia coincides with microcirculatory dysfunction and vascular oxidative stress. Shock. 2008;29:572–6.PubMed
24.
Cabrales P, Vazquez BY, Tsai AG, Intaglietta M. Microvascular and capillary perfusion following glycocalyx degradation. J Appl Physiol. 2007;102:2251–9.PubMedCrossRef
25.
Goldman D, Bateman RM, Ellis CG. Effect of decreased O2 supply on skeletal muscle oxygenation and O2 consumption during sepsis: role of heterogeneous capillary spacing and blood flow. Am J Physiol Heart Circ Physiol. 2006;290:H2277–85.PubMedCrossRef
26.
Walley KR. Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory. J Appl Physiol. 1996;81:885–94.PubMed
27.
Farquhar I, Martin CM, Lam C, Potter R, Ellis CG, Sibbald WJ. Decreased capillary density in vivo in bowel mucosa of rats with normotensive sepsis. J Surg Res. 1996;61:190–6.PubMedCrossRef
28.
Ellis CG, Bateman RM, Sharpe MD, Sibbald WJ, Gill R. Effect of a maldistribution of microvascular blood flow on capillary O(2) extraction in sepsis. Am J Physiol. 2002;282:H156–64.
29.
Humer MF, Phang PT, Friesen BP, Allards MF, Goddard CM, Walley KR. Heterogeneity of gut capillary transit times and impaired gut oxygen extraction in endotoxemic pigs. J Appl Physiol. 1996;81:895–904.PubMed
30.
Legrand M, Bezemer R, Kandil A, Demirci C, Payen D, Ince C. The role of renal hypoperfusion in development of renal microcirculatory dysfunction in endotoxemic rats. Intensive Care Med. 2011;37:1534–42.PubMedCrossRef
31.
Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F. Effects of dobutamine and dopamine on gastric mucosal blood flow in septic patients. Am J Respir Crit Care Med. 1995;151:A446. (Abstract).
32.
Slaaf DW, Tangelder GJ, Reneman RS, Jager K, Bollinger A. A versatile incident illuminator for intravital microscopy. Int J Microcirc Clin Exp. 1987;6:391–7.PubMed
33.
Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG. Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med. 1999;5:1209–12.PubMedCrossRef
34.
Goedhart P, Khalilzada M, Bezemer R, Merza J, Ince C. Sidestreal Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2007;15:15101–14.PubMedCrossRef
35.
Boerma EC, Mathura KR, van der Voort PH, Spronk PE, Ince C. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care. 2005;9:R601–6.PubMedCrossRef
36.
De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C. How to evaluate the microcirculation: report of a round table conference. Crit Care. 2007;11:R101.PubMedCrossRef
37.
Girardis M, Rinaldi L, Busani S, Flore I, Mauro S, Pasetto A. Muscle perfusion and oxygen consumption by near-infrared spectroscopy in septic-shock and non-septic-shock patients. Intensive Care Med. 2003;29:1173–6.PubMedCrossRef
38.
Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ. Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock. 2007;27:348–53.PubMedCrossRef
39.
Pareznik R, Knezevic R, Voga G, Podbregar M. Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med. 2006;32:87–92.PubMedCrossRef
40.
De Blasi RA, Palmisani S, Alampi D, Mercieri M, Romano R, Collini S, Pinto G. Microvascular dysfunction and skeletal muscle oxygenation assessed by phase-modulation near-infrared spectroscopy in patients with septic shock. Intensive Care Med. 2005;31:1661–8.PubMedCrossRef
41.
Nevière R, Mathieu D, Chagnon JL, Lebleu N, Millien JP, Wattel F. Skeletal muscle microvascular blood flow and oxygen transport in patients with severe sepsis. Am J Respir Crit Care Med. 1996;153:191–5.PubMed
42.
Schlichtig R, Bowles SA. Distinguishing between aerobic and anaerobic appearance of dissolved CO2 in intestine during low flow. J Appl Physiol. 1994;76:2443–51.PubMed
43.
Levy B, Gawalkiewicz P, Vallet B, Briancon S, Nace L, Bollaert PE. Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients. Crit Care Med. 2003;31:474–80.PubMedCrossRef
44.
Weil MH, Nakagawa Y, Tang W, Sato Y, Ercoli F, Finegan R, Grayman G, Bisera J. Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med. 1999;27:1225–9.PubMedCrossRef
45.
46.
Creteur J, De Backer D, Sakr Y, Koch M, Vincent JL. Sublingual capnometry tracks microcirculatory changes in septic patients. Intensive Care Med. 2006;32:516–23.PubMedCrossRef
47.
Vallee F, Mateo J, Dubreuil G, Poussant T, Tachon G, Ouanounou I, Payen D. Cutaneous ear lobe PCO2 at 37{degrees}C to evaluate micro perfusion in septic patients. Chest. 2010;138:1062–70.PubMedCrossRef
48.
Dammers R, Wehrens XH, Oude EM, Slaaf DW, Kurvers HA, Ramsay G. Microcirculatory effects of experimental acute limb ischaemia-reperfusion. Br J Surg. 2001;88:816–24.PubMedCrossRef
49.
Hoffmann JN, Vollmar B, Laschke MW, Fertmann JM, Jauch KW, Menger MD. Microcirculatory alterations in ischemia-reperfusion injury and sepsis: effects of activated protein C and thrombin inhibition. Crit Care. 2005;9(Suppl 4):S33–7.PubMedCrossRef
50.
Nolte D, Zeintl H, Steinbauer M, Pickelmann S, Messmer K. Functional capillary density: an indicator of tissue perfusion? Int J Microcirc Clin Exp. 1995;15:244–9.PubMedCrossRef
Metadata
Title
Monitoring the microcirculation
Authors
Daniel De Backer
Katia Donadello
Diego Orbegozo Cortes
Publication date
01-10-2012
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 5/2012
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-012-9383-8

Other articles of this Issue 5/2012

Journal of Clinical Monitoring and Computing 5/2012 Go to the issue

INVITED REVIEW

Hemodynamic management of cardiovascular failure by using PCO2 venous-arterial difference

INVITED REVIEW

The pulmonary artery catheter

INVITED REVIEW

Cardiopulmonary interactions and volume status assessment

INVITED REVIEW

Generic and patient-specific models of the arterial tree

Editorial

Hemodynamic monitoring development: helpful technology or expensive luxury?

Invited Review

The transpulmonary thermodilution technique