Microvascular dysfunction in the surgical patient

Current Opinion in Critical Care

Volumn 16, Issue 4, 2010, Pages 377-383

  Vellinga, Namkje A R ^a,b   Ince, Can ^a   Boerma, E Christiaan ^a,b  

^a ACADEMIC MEDICAL CENTER   (Netherlands)

^b MEDICAL CENTER LEEUWARDEN   (Netherlands)

Author keywords

Anaesthesia; Microcirculation; Organ perfusion; Surgery

Indexed keywords

ASPARTATE AMINOTRANSFERASE; BILIRUBIN; CISATRACURIUM; ENOXIMONE; GELATIN; GLYCERYL TRINITRATE; HEMOGLOBIN; INDOCYANINE GREEN; KETANSERIN; LACTIC ACID; MIDAZOLAM; NORADRENALIN; OXYGEN; PANCURONIUM BROMIDE; PHENYLEPHRINE; PROPOFOL; PYRUVIC ACID; REMIFENTANIL; SUFENTANIL; VASOACTIVE AGENT; VASOPRESSIN;

ABDOMINAL PRESSURE; ABDOMINAL SURGERY; AEROBIC METABOLISM; ANASTOMOSIS LEAKAGE; ANESTHESIA; ANESTHESIA INDUCTION; ASPARTATE AMINOTRANSFERASE BLOOD LEVEL; BILIRUBIN BLOOD LEVEL; BLOOD PRESSURE REGULATION; BLOOD VESSEL REACTIVITY; BRAIN MICROCIRCULATION; CARDIOGENIC SHOCK; CARDIOPULMONARY BYPASS; CARDIOVASCULAR EFFECT; COLORECTAL ANASTOMOSIS; CRYSTALLOID; DRUG CLEARANCE; DRUG DOSE COMPARISON; DRUG MEGADOSE; ENDOTHELIAL DYSFUNCTION; FLUID THERAPY; GENERAL SURGERY; GLOMERULUS FILTRATION RATE; HEART FAILURE; HEART SURGERY; HEMODILUTION; HEMODYNAMICS; HEMOGLOBIN BLOOD LEVEL; HUMAN; HYPERTENSION; HYPOTENSION; INTENSIVE CARE; INTESTINE SURGERY; LACTATE BLOOD LEVEL; LASER DOPPLER FLOWMETRY; LOW DRUG DOSE; MEAN ARTERIAL PRESSURE; MICROANGIOPATHY; MICROCIRCULATION; MICROVASCULATURE; NONHUMAN; OFF PUMP CORONARY SURGERY; ORGAN PERFUSION; OXYGEN TRANSPORT; PERIOPERATIVE COMPLICATION; PERIOPERATIVE PERIOD; PREOPERATIVE CARE; PROGNOSIS; PULSATILE FLOW; QUANTITATIVE ANALYSIS; REVIEW; SEPSIS; SUBLINGUAL MICROCIRCULATION; SURGICAL PATIENT; SURGICAL TECHNIQUE; THORAX EPIDURAL ANESTHESIA; VASCULAR SURGERY; VASOCONSTRICTION;

ANASTOMOSIS, SURGICAL; CARDIOPULMONARY BYPASS; ENDOTHELIUM, VASCULAR; GENERAL SURGERY; HEMODYNAMICS; HUMANS; INCIDENCE; MICROCIRCULATION; PERFUSION; POSTOPERATIVE COMPLICATIONS; PROGNOSIS; RISK FACTORS;

EID: 78449292479     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e32833a0633     Document Type: Review

References (74)

1. Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 2009; 250:1029-1034.
2. Roche AM, Miller TE, Gan TJ. Goal-directed fluid management with trans-oesophageal Doppler. Best Pract Res Clin Anaesthesiol 2009; 23:327-334.
3. Donati A, Cornacchini O, Loggi S, et al. A comparison among portal lactate, intramucosal sigmoid Ph, and deltaCO2 (PaCO2-regional Pco2) as indices of complications in patients undergoing abdominal aortic aneurysm surgery. Anesth Analg 2004; 99:1024-1031.
4. Hirano Y, Omura K, Tatsuzawa Y, et al. Tissue oxygen saturation during colorectal surgery measured by near-infrared spectroscopy: pilot study to predict anastomotic complications. World J Surg 2006; 30:457-461.
5. Lebuffe G, Decoene C, Pol A, et al. Regional capnometry with air-automated tonometry detects circulatory failure earlier than conventional hemodynamics after cardiac surgery. Anesth Analg 1999; 89:1084-1090.
6. Mandak J, Pojar M, Cibicek N, et al. Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow. Perfusion 2008; 23:339-346.
7. Arnold RC, Parrillo JE, Phillip Dellinger R, et al. Point-of-care assessment of microvascular blood flow in critically ill patients. Intensive Care Med 2009; 35:1761-1766.
8. De Backer D, Creteur J, Dubois MJ, et al. Microvascularalterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004; 147:91-99.
9. Trzeciak S, Dellinger RP, Parrillo JE, et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med 2007; 49:88-98.
10. Groner W, Winkelman JW, Harris AG, et al. Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 1999; 5:1209-1212.
11. Goedhart PT, Khalilzada M, Bezemer R, et al. Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Optics express 2007; 15:15101-15114.
12. De Backer D, Hollenberg S, Boerma C, et al. How to evaluate the micro-circulation: report of a round table conference. Crit Care 2007; 11:R101.
13. Boerma EC, Mathura KR, van der Voort PHJ, et al. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a pro-spective validation study. Crit Care 2005; 9:R601-R606.
14. Krogh A. The number and distribution of capillaries in muscles with calcula-tions of the oxygen pressure head necessary for supplying thetissue. J Physiol 1919; 52:409-415.
15. Jhanji S, Lee C, Watson D, et al. Microvascular flow and tissue oxygenation after major abdominal surgery: association with postoperative complications. Intensive Care Med 2009; 35:671-677.
16. Turek Z, Sykora R, Matejovic M, Cerny V. Anesthesia and the microcirculation. Semin Cardiothorac Vasc Anesth 2009; 13:249-258.
17. De Backer D, Dubois MJ, Schmartz D, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg 2009; 88:1396-1403.
18. den Uil CA, Lagrand WK, Spronk PE, et al. Impaired sublingual microvascular perfusion during surgery with cardiopulmonary bypass: a pilot study. J Thorac Cardiovasc Surg 2008; 136:129-134.
19. Darrouj J, Karma L, Arora R. Cardiovascular manifestations of sedatives and analgesics in the critical care unit Am J Ther 2009; 16:339-353.
20. Koch M, De Backer D, Vincent JL, et al. Effects of propofol on human microcirculation. Br J Anaesth 2008; 101:473-478.
21. Jung C, Rödiger C, Lauten A, et al. Die Langzeitgabe von Propofol hat keinen Einflussaufdie Mikrozirkulation bei internistischen Intensivpatienten. Med Klin (Munich) 2009; 104:336-342.
22. Klein KU, Schramm P, Glaser M, et al. Intraoperative monitoring of cerebral microcirculation and oxygenation: a feasibility study using a novel photospectrometric laser-Doppler flowmetry. J Neurosurg Anesthesiol 2010; 22:38-45.
23. Kortgen A, Silomon M, Pape-Becker C, et al.Thoracic butnot lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery. Eur J Anaesthesiol 2009; 26:111-116.
24. Huybregts RAJM, deVroege R,Jansen EK, et al.Theassociation ofhemodilu-tion and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass. Anesth Analg 2009; 109:331-339.
25. Kourliouros A, Valencia O, Phillips SD, et al. Low cardiopulmonary bypass perfusion temperatures are associated with acute kidney injury following coronary artery bypass surgery. Eur J Cardiothorac Surg 2009 [Epub].
26. Presta P, Onorati F, Fuiano L, et al. Can pulsatile cardiopulmonary bypass prevent perioperative renal dysfunction during myocardial revascularization in elderly patients? Nephron Clin Pract 2009; 111:c229-c235.
27. O'Dwyer C, Woodson LC, Conroy BP, et al. Regional perfusion abnormalities with phenylephrine during normothermic bypass. Ann Thorac Surg 1997; 63:728-735.
28. Bauer A, Kofler S, Thiel M, et al. Monitoring of the sublingual microcirculation in cardiac surgery using orthogonal polarization spectral imaging: preliminary results. Anesthesiology 2007; 107:939-945.
29. Maier S, Hasibeder WR, Hengl C, et al. Effects of phenylephrine on the sublingual microcirculation during cardiopulmonary bypass. Br J Anaesth 2009; 102:485-491.
30. Elbers PWG, Ozdemir A, van Iterson M, et al. Microcirculatory imaging in cardiac anesthesia: ketanserin reduces blood pressure but not perfused capillary density. J Cardiothorac Vasc Anesth 2009; 23:95-101.
31. Boerma EC, Konijn A, Kaiferova K, Ince C. Low incidence of rectal micro-circulatory flow alterations after cardiac surgery. Intensive Care Med 2008; 349 (Suppl 1):S151.
32. Nygren A, Thorén A, Houltz E, Ricksten SE. Autoregulation of human jejunal mucosal perfusion during cardiopulmonary bypass. Anesth Analg 2006; 102:1617-1622.
33. Onorati F, Santarpino G, Tangredi G, et al. Intra-aortic balloon pump induced pulsatile perfusion reduces endothelial activation and inflammatory response following cardiopulmonary bypass. Eur J Cardiothorac Surg 2009; 35:1012-1019.
34. den Uil CA, Maat AP, Lagrand WK, et al. Mechanical circulatory support devices improve tissue perfusion in patients with end-stage heart failure or cardiogenic shock. J Heart Lung Transplant 2009; 28:906-911.
35. Lam K, Sjauw KD, Henriques JPS, et al. Improved microcirculation in patients with an acute ST-elevation myocardial infarction treated with the Impella LP2.5 percutaneous left ventricular assist device. Clin Res Cardiol 2009; 98:311-318.
36. Jung C, Rödiger C, Fritzenwanger M, et al. Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock. Clin Res Cardiol 2009; 98:469-475.
37. Lanzarone E, Gelmini F, Tessari M, et al. Preservation of endothelium nitric oxide release by pulsatile flow cardiopulmonary bypass when compared with continuous flow. Artif Organs 2009; 33:926-934.
38. Chappell D, Westphal M, Jacob M. The impact of the glycocalyx on micro-circulatory oxygen distribution in critical illness. Curr Opin Anaesthesiol 2009; 22:155-162.
39. Nieuwdorp M, Meuwese MC, Mooij HL, et al. Measuring endothelial glyco-calyx dimensions in humans: a potential novel tool to monitor vascular vulnerability. J Appl Physiol 2008; 104:845-852.
40. Rehm M, Bruegger D, Christ F, et al. Shedding of theendothelial glycocalyx in patients undergoing majorvascularsurgerywith global and regional ischemia. Circulation 2007; 116:1896-1906.
41. Svennevig K, Hoel T, Thiara A, et al. Syndecan-1 plasma levels during coronary artery bypass surgery with and without cardiopulmonary bypass. Perfusion 2008; 23:165-171.
42. Atasever B, Boer C, van der Kuil, M, et al. Quantitative imaging of micro-circulatoryresponseduring nitroglycerin-induced hypotension. J Cardiothorac Vasc Anesth 2010 [Epub].
43. Nygren A, Thorén A, Ricksten SE. Vasopressin decreases intestinal mucosal perfusion: a clinical study on cardiac surgery patients in vasodilatory shock. Acta Anaesthesiol Scand 2009; 53:581-588.
44. Bragadottir G, Redfors B, Nygren A, et al. Low-dose vasopressin increases glomerularfiltration rate, but impairs renal oxygenation in postcardiac surgery patients. Acta Anaesthesiol Scand 2009; 53:1052-1059.
45. Dubin A, Pozo MO, Casabella CA, et al. Increasing arterial blood pressurewith norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care 2009; 13:R92.
46. Jhanji S, Stirling S, Patel N, et al. The effect of increasing doses of norepi-nephrine on tissue oxygenation and microvascularflow in patientswith septic shock. Crit Care Med 2009; 37:1961-1966.
47. Taylor AE, Moore TM. Capillary fluid exchange. Am J Physiol 1999; 277: S203-S210.
48. Hoff DAL, Gregersen H, Hatlebakk JG. Mucosal blood flow measurements using laser Doppler perfusion monitoring. World J Gastroenterol 2009; 15:198-203.
49. Mahmood A, Gosling P, Barclay R, et al. Splanchnic microcirculation protection by hydroxyethyl starchesduring abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg 2009; 37:319-325.
50. Millan M, Garćia-Granero E, Flor B, et al. Early prediction of anastomotic leak in colorectal cancer surgery by intramucosal pH. Dis Colon Rectum 2006; 49:595-601.
51. Nakatsuka M. Assessment of gut mucosal perfusion and colonictissue blood flow during abdominal aortic surgery with gastric tonometry and laser Doppler flowmetry. Vasc Endovascular Surg 2002; 36:193-198.
52. Leppikangas H, Tenhunen JJ, Lindgren L, et al. Effects of levosimendan on indocyanine green plasma disappearance rate and the gastric mucosal-arterial pCO2 gradient in abdominal aortic aneurysm surgery. Acta Anaes-thesiol Scand 2008; 52:785-792.
53. Boerma EC, van der Voort PHJ, Spronk PE, Ince C. Relationship between sublingual and intestinal microcirculatory perfusion in patientswith abdominal sepsis. Crit Care Med 2007; 35:1055-1060.
54. Derikx JPM, van Waardenburg DA, Thuijls G, et al. New insight in loss of gut barrier during major non-abdominal surgery. PloS One 2008; 3:e3954.
55. Puhl G, Schaser KD, Vollmar B, et al. Noninvasive in vivoanalysisof the human hepatic microcirculation using orthogonal polorization spectral imaging. Transplantation 2003; 75:756-761.
56. Mathura KR, Bouma GJ, Ince C. Abnormal microcirculation in brain tumours during surgery. Lancet 2001; 358:1698-1699.
57. Schmitz V, Schaser KD, Olschewski P, et al. In vivo visualization of early microcirculatory changes following ischemia/reperfusion injury in human kidney transplantation. Eur Surg Res 2008; 40:19-25.
58. Schaser KD, Puhl G, Vollmar B, et al. In vivo imaging of human pancreatic microcirculation and pancreatic tissue injury in clinical pancreas transplanta-tion. Am J Transplant 2005; 5:341-350.
59. Ladurner R, Feilitzsch M, Steurer W, et al. The impact of a micro-lightguide spectrophotometer on the intraoperative assessment of hepatic microcircula-tion: a pilot study. Microvasc Res 2009; 77:387-388.
60. den Uil CA, Bezemer R, Miranda DR, et al. Intra-operative assessment of human pulmonary alveoli in vivo using Sidestream Dark Field imaging: a feasibility study. Med Sci Monit 2009; 15:MT137-MT141.
61. Malbrain MLNG, De laet IE. Intra-abdominal hypertension: evolving concepts. Clin Chest Med 2009; 30:45-70; viii.
62. Djavani K, Wanhainen A, Valtysson J, Björck M. Colonic ischaemia and intra-abdominal hypertension following open repair of ruptured abdominal aortic aneurysm. Br J Surg 2009; 96:621-627.
63. Sassa N, Hattori R, Yamamoto T, et al. Direct visualization of renal hemody-namics affected by carbon dioxide-induced pneumoperitoneum. Urology 2009; 73:311-315.
64. Wauters J, Claus P, Brosens N, et al. Pathophysiology of renal hemodynamics and renal cortical microcirculation in a porcine model of elevated intraabdominal pressure.JTrauma2009; 66:713-719.
65. Bishara B, Karram T, Khatib S, et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc 2009; 23:568-576.
66. Hiltebrand LB, Kimberger O, Arnberger M, et al. Crystalloids versus colloids for goal-directed fluid therapy in major surgery. Crit Care 2009; 13:R40.
67. Kimberger O, Arnberger M, Brandt S, et al. Goal-directed colloid adminis-tration improves the microcirculation of healthy and perianastomotic colon. Anesthesiology 2009; 110:496-504.
68. Puhl G, Schaser KD, Pust D, et al. Initial hepatic microcirculation correlates with earlygraftfunction in human orthotopic livertransplantation. Liver Transpl 2005; 11:555-563.
69. Karliczek A, Benaron DA, Baas PC, et al. Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Colorectal Dis 2009 [Epub].
70. Ellebaek Pedersen M, Qvist N, Bisgaard C, et al. Peritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer. Scand J Surg 2009; 98:148-154.
71. Buise MP, Ince C, Tilanus HW, et al. The effect of nitroglycerin on micro-vascular perfusion and oxygenation during gastric tube reconstruction. An-esth Analg 2005; 100:1107-1111.
72. Buise M, van Bommel J, Jahn A, et al. Intravenous nitroglycerin does not preserve gastric microcirculation during gastric tube reconstruction: a ran-domized controlled trial. Crit Care 2006; 10:R131.
73. Klijn E, Niehof S, deJonge J, et al. The effect of perfusion pressure on gastric tissue blood flow in an experimental gastric tube model. Anesth Analg 2010; 110:541-546.
74. Van Bommel J, De Jonge J, Buise MP, et al. The effects of intravenous nitroglycerine and norepinephrine on gastric microvascular perfusion in an experimental model of gastric tube reconstruction. Surgery 2010 [Epub].