ABSTRACTS from 16th International COnference on ... - CRRT Online

A01
Assessing the Microcirculation
Educational Objectives:
1. Discuss the different methods for evaluating the microcirculation
Rolando Claure MD
4:00-5:30
Tuesday, February 14
2. To review the different scores available for microcirculation analysis, and which measurements should be
included.
3. Discuss how monitoring of the microcirculation may help us at the bedside
Content Description:
Microvascular perfusion plays an important role in the development of organ failure in hospitalized patients.
Although microcirculation is the primary site of oxygen and nutrient exchange, microvascular oxygen delivery
cannot be predicted <strong>from</strong> global hemodynamic measurements. Hemodynamic assessment has been limited to
measurements of cardiac output and oxygen delivery, which are indirect measurements of microcirculation.
However, several observational studies and randomized controlled trials trying to improve these parameters
based on information derived <strong>from</strong> pulmonary artery catheter have shown no benefits in outcomes.
In critically-ill patients improvement in microvascular perfusion should be to one of the major therapeutic goals.
Recent advances in technology have allowed direct visualization of the microcirculation. The octagonal polarization
spectral (OPS) and the side stream dark field (SDF) imaging devices provide high contrast images of the
microvasculature. Experimental studies have shown alterations in the microcirculation common to different
pathological process. OPS and SDF imaging have been used to assess microvascular alterations in many disease
processes such as: sepsis, painful crises in sickle cell disease, bacterial infection in cirrhosis, leukostasis in
patients with chronic myeloid leukemia, and changes in the volume status of hemodialysis patient. It has also
been used to assess the effect of different therapies on microcirculation in experimental animal models and in
septic patients. Additionally, in critically-ill patients with sepsis and septic shock, recent studies have correlated
microcirculatory flow abnormalities with hemodynamics, oxygen transport and survival.
The introduction of OPS and SDF imaging has opened challenging new perspectives in in vivo research of
microcirculatory alterations, and has highlighted the importance of microcirculatory alterations in multiple organ
failure and sepsis.
Suggested Reading:
1. van Beers EJ, Goedhart PT, Unger M, Biemond BJ, Ince C. Normal sublingual microcirculation during
painful crisis in sickle cell disease. Microvascular Research 76:57 60, 2008.
2. Sheikh, M. Y., U. Javed, et al. Bedside Sublingual Video Imaging of Microcirculation in Assessing Bacterial
Infection in Cirrhosis. Dig Dis Sci, 2009
3. Boerma EC, van del Voort PHJ, Spronk PE, et al. Relationship between sublingual and intestinal microcirculatory
perfusion in patients with abdominal sepsis. Crit Care Med 35:1055 1060, 2007.
4. Trzeciak S, Dellinger PR, 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
49:88-98, 2007.
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