Marker Of Microcirculation Research Articles

Comparison of Predictive Ability of Macrocirculation and Microcirculation Markers on Outcomes of Patients with Septic Shock During Initial Fluid Resuscitation: A Prospective Observational Study

IntroductionThis study aimed to compare the predictive abilities of macrocirculation markers (mean arterial pressure, heart rate, and central venous pressure), microcirculation markers (capillary refill time and peripheral perfusion index), as well as fluid balance, lactate level, and lactate clearance on the outcomes of patients with septic shock during initial resuscitation.MethodsIn this prospective, single-center observational study, adult patients with septic shock admitted to the intensive care unit (ICU) at Shohada Hospital in Tabriz, Iran, between December 2020 and September 2021, were included. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the associations between macrocirculation markers (heart rate, mean arterial pressure, central venous pressure, and fluid balance) and microcirculation markers (capillary refill time, peripheral perfusion index, mottling score, lactate level, and lactate clearance level) with outcomes such as ICU length of stay, need for renal replacement therapy (RRT), vasopressor requirements, duration of mechanical ventilation (MV), and mortality rate. Assessments were performed at baseline, 6 h, and 24 h after fluid resuscitation.ResultsA total of 100 patients with septic shock (55 men and 45 women) were enrolled in the study. The area under the curve (AUC) values for the macrocirculation and microcirculation markers in predicting mortality ranged from 0.517 to 0.770 and 0.695 to 0.993, respectively. Among the macrocirculation markers, central venous pressure and mean arterial pressure at baseline showed the best predictive values for mortality, with AUCs of 0.770 and 0.753, respectively.ConclusionIn patients with septic shock, microcirculation markers, particularly the peripheral perfusion index (PPI), demonstrated better predictive accuracy for mortality compared to macrocirculation markers. Furthermore, the combination of markers had a higher AUC, sensitivity, and specificity for predicting outcomes compared to individual markers alone.

Utility of superb microvascular imaging for assessment of foot perfusion in patients with critical limb ischemia

Abstract Background Recently, an increasing attention has been paid to foot microcirculation in critical limb ischemia (CLI). Although skin perfusion pressure (SPP) is the most frequently used marker of microcirculation, SPP is often unmeasurable at the most ischemic site in the foot. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low velocity flows and enables the quantitative verification as vascular index (VI). We examined the diagnostic value of SMI-based VI in assessing foot perfusion when planning endovascular treatment (EVT). Methods Consecutive 50 patients with CLI were enrolled. All cases underwent EVT for superficial femoral arteries. SMI-based VI of plantar, dorsal, medial heel, lateral heel and toe's area were obtained before and after EVT, and those were compared with SPP (plantar and dorsal) or ankle-brachial index (ABI) representing macrocirculation. Results Based on the six angiosomes concept, SMI enabled to visualize microcirculation in all subjects, but SPP was not feasible in 13% of all subjects at the most ischemic site. After EVT, ABIs were significantly increased from 0.64±0.19 to 0.85±0.27 (P=0.0003). Plantar SPP also increased from 39.6±20.4 mmHg to 58.5±27.1 mmHg (p=0.002). SMI-based VI significantly increased in each sites based on the six angiosomes concept. Of note, plantar SMI-based VI significantly increased from 5.1±3.2% to 10.6±6.6% (p<0.0001), suggesting improvement of foot perfusion. Plantar SMI-based VI was well correlated with plantar-SPP both before and after EVT (p=0.002, r=0.663). Plantar VI was also informative in showing a rapid improvement of foot perfusion during EVT. Conclusion SMI enabled to visualize the foot microcirculation on the basis of angiosomes concept. SMI has potential as an alternative to SPP. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in -Aid for Scientific Reseach, Japan

ASSESSMENT OF FOOT MICROCIRCULATION BY USING SUPERB MICROVASCULAR IMAGING IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Recently, an increasing attention has been paid to foot microcirculation in critical limb ischemia (CLI). Although skin perfusion pressure (SPP) is the most frequently used marker of microcirculation, SPP is often unmeasurable at the most ischemic site in the foot. A new ultrasound technique (superb

The effects of lower limb intermittent negative pressure therapy on the skin microcirculation perfusion of quadriceps in male rowers

To investigate the effects of intermittent negative pressure therapy on the skin microcirculation perfusion of quadriceps in male rowers, and to provide basis for the practical application of this method. Fourteen male rowers were selected from the national rowing team and randomly divided into experimental and control groups. The daily training plans of two groups were the same. The recovery intervention for experimental group was implemented by 20 minutes in the cube of Vacusport Regeneration System (German), 5 times per week for 4 weeks, no recovery intervention for control group. Microcirculation markers were collected by PeriFlux5000 system before and after the 4-week intervention. The markers included microcirculatory blood perfusion(MBP), average velocity of blood cells(AVBC), concentration of moving blood cells (CMBC), and values of the markers included basic values and post-heating values (44℃), difference before and after heating of the values was considered as the reserve capacity of those markers. The test results before the 4 weeks intervention showed there was no statistical difference between the two groups(P＞0.05). After the 4 weeks intervention: ①MBP: The post-heating value and the difference of the experimental group were significantly higher than those of the control group (P＜0.05). But there was no statistical inner-group difference. ②AVBC: The post-heating values and the difference in the experimental group were significantly lower than those in the control group (P＜0.05). Intra-group comparison found that the post-heating values after post-intervention were significantly reduced, compared with those of pre-intervention (P＜ 0.01); the difference after post-intervention was reduced significantly, compared with those in the pre-intervention (P＜0.05). ③CMBC: The post-heating values and the difference in the experimental group were significantly higher than those in the control group (P＜0.01). There were no statistical significant inner-group difference. Lower limb intermittent negative pressure therapy can improve the skin microcirculation of the quadriceps of the male rowers, which has a positive effect on the rapid recovery of physical fitness.

Effects of vitamin supplementation on microcirculatory disturbance in hemodialysis patients without peripheral arterial disease.

Dysfunctional endothelium caused by oxidative stress is thought to play a role in pathogenesis of a variety of conditions including atherosclerosis. We investigated whether a microcirculatory disturbance in hemodialysis (HD) patients was associated with increased oxidative stress and endothelial injury. Transcutaneous oxygen tension (TcPO2) on the dorsum of the foot at rest was measured as a marker of microcirculation in 33 patients undergoing HD without clinical manifestations of peripheral arterial disease and 20 healthy controls. Furthermore, in order to examine whether TcPO2 was affected by antioxidants, oral supplementation with a combination of vitamin C (200 mg daily) and vitamin E (600 mg daily) was administered for 6 months to 8 patients with microcirculatory disturbance (TcPO2 values of 50 mmHg or less). Serum biochemical parameters including vitamins were also measured. Mean TcPO2 value was significantly lower in HD patients than in control subjects (47.9 +/- 13.5 mmHg versus 62.4 +/- 11.9 mmHg, p < 0.001). After vitamin supplementation, TcPO2 values remarkably increased (40.6 +/- 10.0 mmHg versus 57.4 +/- 6.5 mmHg, p < 0.005). Serum vitamin C and vitamin E levels increased significantly as well, while serum levels of thrombomodulin, a marker of endothelial injury, and thiobarbituric acid reactants, a marker of lipid peroxidation, were significantly decreased in comparison with those before supplementation. Our results suggest that the microcirculatory disturbance in HD patients seems to be associated with endothelial damage caused by oxidative stress. Combined supplementation with vitamin C and vitamin E may be of clinical benefit in improving the cutaneous microcirculation by reducing oxidative stress.