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Clinical Autonomic Research
Published in: Clinical Autonomic Research 6/2015

Open Access 01-12-2015 | Research Article

Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases

Authors: Eva Klijn, Sjoerd Niehof, A. B. Johan Groeneveld, Alexandre Pinto Lima, Jan Bakker, Jasper van Bommel

Published in: Clinical Autonomic Research | Issue 6/2015

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Abstract

Purpose

Microvascular perfusion may be a non-invasive indicator of fluid responsiveness. We aimed to investigate which of the microvascular perfusion parameters truly reflects fluid responsiveness independent of sympathetic reflexes.

Methods

Fifteen healthy volunteers underwent a postural change from head up tilt (HUT) to the supine position, diminishing sympathetic tone, followed by a 30° passive leg raising (PLR) with unaltered tone. Prior to and after the postural changes, stroke volume (SV) and cardiac output (CO) were measured, as well as sublingual microcirculatory perfusion (sidestream dark field imaging), skin perfusion, and oxygenation (laser Doppler flowmetry and reflectance spectroscopy).

Results

In responders (subjects with >10 % increase in CO), the HUT to supine change increased CO, SV, and pulse pressure, while heart rate, systemic vascular resistance, and mean arterial pressure decreased. Additionally, microvascular flow index, laser Doppler flow, and microvascular hemoglobin oxygen saturation and concentration also increased.

Conclusion

When preload and forward flow increase in association with a decrease in sympathetic activity, microvascular blood flow increases in the skin and in the sublingual area. When preload and forward flow increase with little to no change in sympathetic activity, only sublingual functional capillary density increases. Therefore, our results indicate that sublingual functional capillary density is the best parameter to use when evaluating fluid responsiveness independent of changes in sympathetic tone.
Literature
1.
De Backer D, Donadello K, Sakr Y, Ospina-Tascon G, Salgado D, Scolletta S, Vincent JL (2013) Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 41:791–799CrossRefPubMed
2.
Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Buchele G, Simion D, Chierego ML, Silva TO, Fonseca A, Vincent JL, De Backer D (2010) Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med 36:949–955CrossRefPubMed
3.
Pottecher J, Deruddre S, Teboul JL, Georger JF, Laplace C, Benhamou D, Vicaut E, Duranteau J (2010) Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med 36:1867–1874CrossRefPubMed
4.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, Vincent JL (2006) The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 34:403–408CrossRefPubMed
5.
Arnold RC, Dellinger RP, Parrillo JE, Chansky ME, Lotano VE, McCoy JV, Jones AE, Shapiro NI, Hollenberg SM, Trzeciak S (2012) Discordance between microcirculatory alterations and arterial pressure in patients with hemodynamic instability. J Crit Care 27:531–537CrossRefPubMed
6.
Huijben AM, Mattace-Raso FU, Deinum J, Lenders J, van den Meiracker AH (2012) Aortic augmentation index and pulse wave velocity in response to head-up tilting: effect of autonomic failure. J Hypertens 30:307–314CrossRefPubMed
7.
Cooke WH, Ryan KL, Convertino VA (2004) Lower body negative pressure as a model to study progression to acute hemorrhagic shock in humans. J Appl Physiol 96:1249–1261CrossRefPubMed
8.
Kitano A, Shoemaker JK, Ichinose M, Wada H, Nishiyasu T (2005) Comparison of cardiovascular responses between lower body negative pressure and head-up tilt. J Appl Physiol 98:2081–2086CrossRefPubMed
9.
Rutlen DL, Wackers FJ, Zaret BL (1981) Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation 64:146–152CrossRefPubMed
10.
Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G (2002) Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 121:1245–1252CrossRefPubMed
11.
12.
13.
De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101PubMedCentralCrossRefPubMed
14.
15.
Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008CrossRefPubMed
16.
Raj SR, Coffin ST (2013) Medical therapy and physical maneuvers in the treatment of the vasovagal syncope and orthostatic hypotension. Prog Cardiovasc Dis 55:425–433PubMedCentralCrossRefPubMed
17.
Rao RP, Danduran MJ, Dixon JE, Frommelt PC, Berger S, Zangwill SD (2010) Near infrared spectroscopy: guided tilt table testing for syncope. Pediatr Cardiol 31:674–679CrossRefPubMed
18.
Abboud FM, Eckberg DL, Johannsen UJ, Mark AL (1979) Carotid and cardiopulmonary baroreceptor control of splanchnic and forearm vascular resistance during venous pooling in man. J Physiol 286:173–184PubMedCentralCrossRefPubMed
19.
Poliner LR, Dehmer GJ, Lewis SE, Parkey RW, Blomqvist CG, Willerson JT (1980) Left ventricular performance in normal subjects: a comparison of the responses to exercise in the upright and supine positions. Circulation 62:528–534CrossRefPubMed
Metadata
Title
Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases
Authors
Eva Klijn
Sjoerd Niehof
A. B. Johan Groeneveld
Alexandre Pinto Lima
Jan Bakker
Jasper van Bommel
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 6/2015
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-015-0286-x

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