Abstract
IntroductionMicrovascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes.MethodsWe retrospectively analyzed a prospectively collected registry. In total, 254 consecutive adult patients undergoing cardiac and thoracic aortic surgeries from January 2013 through May 2014 were analyzed. We performed a vascular occlusion test (VOT) by using near-infrared spectroscopy to measure microvascular reactivity. VOT was performed three times per patient: prior to the induction of anesthesia, at the end of surgery, and on postoperative day 1. The primary endpoint was a composite of major adverse complications, including death, myocardial infarction, acute kidney injury, acute respiratory distress syndrome, and persistent cardiogenic shock.ResultsVOT recovery slope decreased during the surgery. VOT recovery slope on postoperative day 1 was significantly lower in patients with composite complications than those without (3.1 ± 1.6 versus 4.0 ± 1.5 %/s, P = 0.001), although conventional hemodynamic values, such as cardiac output and blood pressure, did not differ between the groups. On multivariable regression and linear analyses, low VOT recovery slope on postoperative day 1 was associated with increases of composite complications (odds ratio 0.742; 95 % confidence interval (CI) 0.584 to 0.943; P = 0.015) and hospital length of stay (regression coefficient (B) −1.276; 95 % CI −2.440 to −0.112; P = 0.032).ConclusionMicrovascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications.Trial registrationClinicalTrials.gov NCT01713192. Registered 22 October 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1025-3) contains supplementary material, which is available to authorized users.
Highlights
Microvascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes
Microcirculation is decreased in cardiac surgery patients, regardless of whether cardiopulmonary bypass (CPB) was used [8]
The vascular occlusion test (VOT) is a provocative test of the microcirculation, which uses the dynamic response of tissue oxygen saturation (StO2) to transient limb ischemia and reperfusion
Summary
Microvascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes. Tissue hypoperfusion is one of the earliest warning signs in the critically ill [1]. It is considered a predictor of organ ischemia and postoperative clinical outcomes [2,3,4]. The recovery slope of StO2 during the VOT is used as a measure of microvascular reactivity because it reflects post-ischemic reperfusion and hyperemia [10, 11]
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