Abstract
BackgroundRemote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. However, the therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcirculation in patients with sepsis.MethodsThis prospective single-arm trial was performed in a mixed ICU at a tertiary teaching hospital. We included patients with sepsis or septic shock within 24 h of ICU admission. The RIC procedure comprised 3 cycles of brachial cuff inflation to 200 mmHg for 5 min followed by deflation to 0 mmHg for another 5 min. The procedure took 30 min. RIC was performed at the time of study inclusion and repeated after 12 and 24 h. Sublingual microcirculatory measurements were obtained before and after each RIC procedure using a Cytocam®-incident dark-field (IDF) device (Braedius Medical, Huizen, The Netherlands). The microcirculatory data were compared with a historical control. Data are reported as the medians along with the 25th and 75th percentiles.ResultsTwenty-six septic patients with a median age of 65 (57–81) years were enrolled in this study. The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at admission were 20 (13–23) and 10 (9–12), respectively. All patients were receiving vasopressors. After the 1st RIC procedure, the microvascular flow index (MFI) and the proportion of perfused vessels (PPV) among small vessels were significantly higher than before the procedure, with pre- and post-treatment values of 2.17 (1.81–2.69) and 2.59 (2.21–2.83), respectively, for MFI (p = 0.003) and 87.9 (82.4–93.8) and 92.5 (87.9–96.1) %, respectively, for PPV (p = 0.026). This result was confirmed by comparison with a historical control group. We found no change in microcirculatory flow or density parameters during repeated RIC after 12 h and 24 h.ConclusionIn patients with sepsis, the first remote ischemic conditioning procedure improved microcirculatory flow, whereas later procedures did not affect sublingual microcirculation.Trial registration NCT04644926, http://www.clinicaltrials.gov. Date of registration: 25 November 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04644926.
Highlights
Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes
We found no change in the microvascular flow index (MFI), proportion of perfused vessels (PPV), total vessel density (TVD), perfused vessel density (PVD), or De Backer scores of small vessels after repeated RIC at 12 h and 24 h (Table 2, Fig. 1)
The Spearman correlation coefficient was presented. dMFIs changes in microvascular flow index of small vessels, dPPVs changes in the proportion of perfused small vessels, dMAP changes in mean arterial pressure, dHR changes in heart rate, dCI changes in cardiac index, dScvO2 changes in central venous oxygen saturation, dLactate changes in arterial lactate no significant differences in MFI, PPV, TVD or PVD of small vessels between RIC and historical control at inclusion
Summary
Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. The therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcirculation in patients with sepsis. The global mortality rate from sepsis is considerably high [1]. Sepsis is an infection complicated by impaired microcirculation and abnormal inflammatory response, which eventually leads to multiple organ damage. Altered microcirculation is the cornerstone of sepsis [2]. The severity of microcirculatory alterations during sepsis is Kiudulaite et al Ann. Intensive Care (2021) 11:55 related to mortality [3]. New treatment options for improving or preventing microcirculatory disturbances during sepsis need to be developed. Studies in critically ill patients have usually examined sublingual microcirculation using sidestream dark-field (SDF) or incident dark-field (IDF) imaging
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