Abstract
BackgroundThis study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge.MethodsTwenty-two septic patients in the first postoperative day of an intestinal surgery, in which an ostomy had been constructed, were evaluated both before and 20 min after a challenge of 10 mL/kg of 6% hydroxyethylstarch 130/0.4. We measured systemic hemodynamics and sublingual and intestinal microcirculation. Correlations between variables were determined through the Pearson test.ResultsFluid administration increased the cardiac index (2.6 ± 0.5 vs. 3.3 ± 1.0 L/min/m2, P < 0.01) and mean arterial blood pressure (68 ± 11 vs. 82 ± 12 mm Hg, P < 0.0001). The sublingual but not the intestinal red blood cell (RBC) velocity increased (912 ± 270 vs. 1,064 ± 200 μm/s, P < 0.002 and 679 ± 379 vs. 747 ± 419 μm/s, P = 0.12, respectively). The sublingual and intestinal perfused vascular density (PVD) did not change significantly (15.2 ± 2.9 vs. 16.1 ± 1.2 mm/mm2 and 12.3 ± 6.7 vs. 13.0 ± 6.7 mm/mm2). We found no correlation between the basal sublingual and intestinal RBC velocities or between their changes in response to the fluid challenge. The individual changes in sublingual RBC velocity correlated with those in cardiac index and basal RBC velocity. Individual changes in intestinal RBC velocity did not correlate with either the cardiac index modifications or the basal RBC velocity. The same pattern was observed with the sublingual and the intestinal PVDs. The sublingual RBC velocities and PVDs were similar between survivors and nonsurvivors. But the intestinal RBC velocities and PVDs were lower in nonsurvivors.ConclusionsIn this series of postoperative septic patients, we found a dissociation between sublingual and intestinal microcirculation. The improvement in the sublingual microcirculation after fluid challenge was dependent on the basal state and the increase in cardiac output. In contrast, the intestinal microcirculation behaved as an isolated territory.
Highlights
This study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge
We found that a fluid-mediated improvement in sublingual microcirculation was strongly dependent on the magnitude of the microvascular disorder - the more severe the microcirculatory alteration present, the higher the improvement in response to fluids
1) In this series of postoperative septic patients, we found a significant dissociation among the microcirculatory territories examined in both the basal condition and the response to fluid challenge
Summary
This study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge. The main microvascular alterations consist in a decrease in the proportion of perfused vessels and the perfused vascular density (PVD) along with an increase in vessel heterogeneity [1,2] The presence of these abnormalities identifies the patients with worse outcomes [1,2,3,4,5]. Gut ischemia might be present even when the sublingual mucosa is well perfused The relevance of this issue lies in the possibility that the persistence of villi hypoperfusion may lead to alterations in the barrier function with the subsequent systemic translocation of bacteria and their products, one conceivable mechanism of multiple organ failure [9]
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