Ocular microvascular changes in patients with sepsis: a prospective observational study

Jurate Simkiene,Astra Vitkauskiene,Vidas Pilvinis,E Christiaan Boerma,Andrius Pranskunas,Zivile Pranskuniene

doi:10.1186/s13613-020-00655-x

Abstract

BackgroundThe aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time.MethodsThis single-center prospective observational study was performed in mixed ICU in a tertiary teaching hospital. We included patients with sepsis or septic shock within the first 24 h after ICU admission. Conjunctival imaging, using an IDF video microscope, and retinal imaging, using portable digital fundus camera, as well as systemic hemodynamic measurements, were performed at three time points: at baseline, 6 h and 24 h. Baseline conjunctival microcirculatory parameters were compared with healthy controls.ResultsA total of 48 patients were included in the final assessment and analysis. Median APACHE II and SOFA scores were 16[12–21] and 10[7–12], respectively. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation. 19 (40%) patients were discharged alive from the intensive care unit. We found significant reductions in all microcirculatory parameters in the conjunctiva when comparing septic and healthy subjects. In addition, we observed a significant lower microvascular flow index (MFI) of small conjunctival vessels during all three time points in non-survivors compared with survivors. However, retinal arteriolar vessels were not different between survivors and non-survivors.ConclusionsConjunctival microvascular blood flow was altered in septic patients. In the 24-h observation period conjunctival small vessels had a significantly higher MFI, but no difference in retinal arteriolar diameter in survivors in comparison with non-survivors.Trial registration NCT04214743, https://www.clinicaltrials.gov. Date of registration: 31 December 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04214743

Highlights

The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time
Primary aim of the study: evaluation of the conjunctival microcirculation We found significant reductions in all microcirculatory parameters in the conjunctiva of septic patients when compared to healthy subjects (Table 2)
Association between retinal vascular parameters and conjunctival microcirculatory parameters In septic patients we found no correlations between central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), vascular length density and conjunctival microcirculatory parameters at baseline and after 24 h (Additional file 4)

Summary

Introduction

The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time. The eye is an organ site where the microcirculation can be observed directly in a non-invasive way and such provides a unique opportunity to study changes in the microvasculature in various disease states. Changes of the human microcirculation during sepsis are predominantly evaluated in the sublingual region using handheld microscopes, including Sidestream Dark Field (SDF) imaging. Another accessible spot, such as the conjunctiva, has only been studied in animals during sepsis [13]

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