Microcirculation-guided Resuscitation in Sepsis: the Next Frontier?

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2023 Jul 21

PMID 37476612

Authors

Elisa Damiani

Andrea Carsetti

Erika Casarotta

Roberta Domizi

Claudia Scorcella

Abele Donati

Erica Adrario

Affiliations

Soon will be listed here.

Abstract

Microcirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during sepsis and are associated with poor outcome. More importantly, sublingual videomicroscopy allowed to explore the effects of commonly applied resuscitative treatments in septic shock, such as fluids, vasopressors and inotropes, and showed that the optimization of macro-hemodynamic parameters may not be accompanied by an improvement in microvascular perfusion. This loss of "hemodynamic coherence," i.e., the concordance between the response of the macrocirculation and the microcirculation, advocates for the integration of microvascular monitoring in the management of septic patients. Nonetheless, important barriers remain for a widespread use of sublingual videomicroscopy in the clinical practice. In this review, we discuss the actual limitations of this technique and future developments that may allow an easier and faster evaluation of the microcirculation at the bedside, and propose a role for sublingual microvascular monitoring in guiding and titrating resuscitative therapies in sepsis.

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References

Wang J, Song Q, Yang S, Wang H, Meng S, Huang L . Effects of hydrocortisone combined with vitamin C and vitamin B1 versus hydrocortisone alone on microcirculation in septic shock patients: A pilot study. Clin Hemorheol Microcirc. 2023; 84(2):111-123. PMC: 10357145. DOI: 10.3233/CH-221444. View

Pranskunas A, Pilvinis V, Dambrauskas Z, Rasimaviciute R, Planciuniene R, Dobozinskas P . Early course of microcirculatory perfusion in eye and digestive tract during hypodynamic sepsis. Crit Care. 2012; 16(3):R83. PMC: 3580626. DOI: 10.1186/cc11341. View

Pottecher J, Deruddre S, Teboul J, Georger J, Laplace C, Benhamou D . Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med. 2010; 36(11):1867-74. DOI: 10.1007/s00134-010-1966-6. View

Damiani E, Adrario E, Luchetti M, Scorcella C, Carsetti A, Mininno N . Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis. PLoS One. 2015; 10(5):e0122655. PMC: 4416810. DOI: 10.1371/journal.pone.0122655. View

Donati A, Damiani E, Domizi R, Romano R, Adrario E, Pelaia P . Alteration of the sublingual microvascular glycocalyx in critically ill patients. Microvasc Res. 2013; 90:86-9. DOI: 10.1016/j.mvr.2013.08.007. View

Potter E, Hodgson L, Creagh-Brown B, Forni L . Manipulating the Microcirculation in Sepsis - the Impact of Vasoactive Medications on Microcirculatory Blood Flow: A Systematic Review. Shock. 2018; 52(1):5-12. DOI: 10.1097/SHK.0000000000001239. View

Farquhar I, Martin C, Lam C, Potter R, Ellis C, Sibbald W . Decreased capillary density in vivo in bowel mucosa of rats with normotensive sepsis. J Surg Res. 1996; 61(1):190-6. DOI: 10.1006/jsre.1996.0103. View

Guay C, Khebir M, Shahiri T, Szilagyi A, Cole E, Simoneau G . Evaluation of automated microvascular flow analysis software AVA 4: a validation study. Intensive Care Med Exp. 2021; 9(1):15. PMC: 8017044. DOI: 10.1186/s40635-021-00380-0. View

Piper R, Li F, Sibbald W, Potter R . Microcirculatory changes in rat skeletal muscle in sepsis. Am J Respir Crit Care Med. 1996; 154(4 Pt 1):931-7. DOI: 10.1164/ajrccm.154.4.8887588. View

10.

Carsetti A, Aya H, Pierantozzi S, Bazurro S, Donati A, Rhodes A . Ability and efficiency of an automatic analysis software to measure microvascular parameters. J Clin Monit Comput. 2016; 31(4):669-676. DOI: 10.1007/s10877-016-9928-3. View

11.

Masip J, Mesquida J, Luengo C, Gili G, Goma G, Ferrer R . Near-infrared spectroscopy StO2 monitoring to assess the therapeutic effect of drotrecogin alfa (activated) on microcirculation in patients with severe sepsis or septic shock. Ann Intensive Care. 2013; 3(1):30. PMC: 3847092. DOI: 10.1186/2110-5820-3-30. View

12.

Boerma E, van der Voort P, Spronk P, Ince C . Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis. Crit Care Med. 2007; 35(4):1055-60. DOI: 10.1097/01.CCM.0000259527.89927.F9. View

13.

P Hilty M, Ince C . Automated quantification of tissue red blood cell perfusion as a new resuscitation target. Curr Opin Crit Care. 2020; 26(3):273-280. DOI: 10.1097/MCC.0000000000000725. View

14.

Kanoore Edul V, Ince C, Estenssoro E, Ferrara G, Arzani Y, Salvatori C . The Effects of Arterial Hypertension and Age on the Sublingual Microcirculation of Healthy Volunteers and Outpatients with Cardiovascular Risk Factors. Microcirculation. 2015; 22(6):485-92. DOI: 10.1111/micc.12219. View

15.

Hilty M, Guerci P, Ince Y, Toraman F, Ince C . MicroTools enables automated quantification of capillary density and red blood cell velocity in handheld vital microscopy. Commun Biol. 2019; 2:217. PMC: 6584696. DOI: 10.1038/s42003-019-0473-8. View

16.

Verdant C, De Backer D, Bruhn A, Clausi C, Su F, Wang Z . Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis. Crit Care Med. 2009; 37(11):2875-81. DOI: 10.1097/CCM.0b013e3181b029c1. View

17.

Hilty M, Akin S, Boerma C, Donati A, Erdem O, Giaccaglia P . Automated Algorithm Analysis of Sublingual Microcirculation in an International Multicentral Database Identifies Alterations Associated With Disease and Mechanism of Resuscitation. Crit Care Med. 2020; 48(10):e864-e875. DOI: 10.1097/CCM.0000000000004491. View

18.

Joffre J, Hellman J, Ince C, Ait-Oufella H . Endothelial Responses in Sepsis. Am J Respir Crit Care Med. 2020; 202(3):361-370. DOI: 10.1164/rccm.201910-1911TR. View

19.

Veenstra G, Ince C, Barendrecht B, Zijlstra H, Boerma E . Differences in capillary recruitment between cardiac surgery and septic patients after fluid resuscitation. Microvasc Res. 2018; 123:14-18. DOI: 10.1016/j.mvr.2018.11.006. View

20.

Donati A, Romanelli M, Botticelli L, Valentini A, Gabbanelli V, Nataloni S . Recombinant activated protein C treatment improves tissue perfusion and oxygenation in septic patients measured by near-infrared spectroscopy. Crit Care. 2009; 13 Suppl 5:S12. PMC: 2786114. DOI: 10.1186/cc8010. View