Topical nitroglycerin to detect reversible microcirculatory dysfunction in patients with circulatory shock after cardiovascular surgery: an observational study.

Autor: Greenwood JC; Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. john.greenwood@pennmedicine.upenn.edu.; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. john.greenwood@pennmedicine.upenn.edu.; Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. john.greenwood@pennmedicine.upenn.edu., Talebi FM; Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Jang DH; Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Spelde AE; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Tonna JE; Division of Cardiothoracic Surgery, Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, USA., Gutsche JT; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Horak J; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Acker MA; Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Kilbaugh TJ; Department of Anesthesiology and Critical Care Medicine, Center for Mitochondrial and Epigenomic Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA., Shofer FS; Department of Epidemiology & Biostatistics, Department of Emergency Medicine Hospital, University of Pennsylvania, Philadelphia, PA, USA., Augoustides JGT; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Bakker J; Division of Pulmonary, Allergy, and Critical Care Medicine, New York University, New York, NY, USA.; Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Brenner JS; Division of Pulmonary, Allergy, & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Muzykantov VR; Department of Pharmacology and Center for Translational Targeted Therapeutics and Nanomedicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Abella BS; Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2022 Sep 10; Vol. 12 (1), pp. 15257. Date of Electronic Publication: 2022 Sep 10.
DOI: 10.1038/s41598-022-19741-0
Abstrakt: Persistent abnormalities in microcirculatory function are associated with poor clinical outcomes in patients with circulatory shock. We sought to identify patients with acutely reversible microcirculatory dysfunction using a low-dose topical nitroglycerin solution and handheld videomicroscopy during circulatory shock after cardiac surgery. Forty subjects were enrolled for the study, including 20 preoperative control and 20 post-operative patients with shock. To test whether microcirculatory dysfunction is acutely reversible during shock, the sublingual microcirculation was imaged with incident dark field microscopy before and after the application of 0.1 mL of a 1% nitroglycerin solution (1 mg/mL). Compared to the control group, patients with shock had a higher microcirculation heterogeneity index (MHI 0.33 vs. 0.12, p < 0.001) and a lower microvascular flow index (MFI 2.57 vs. 2.91, p < 0.001), total vessel density (TVD 22.47 vs. 25.90 mm/mm 2 , p = 0.005), proportion of perfused vessels (PPV 90.76 vs. 95.89%, p < 0.001) and perfused vessel density (PVD 20.44 vs. 24.81 mm/mm 2 , p < 0.001). After the nitroglycerin challenge, patients with shock had an increase in MFI (2.57 vs. 2.97, p < 0.001), TVD (22.47 vs. 27.51 mm/mm 2 , p < 0.009), PPV (90.76 vs. 95.91%, p < 0.001), PVD (20.44 vs. 26.41 mm/mm 2 , p < 0.001), venular RBC velocity (402.2 vs. 693.9 µm/s, p < 0.0004), and a decrease in MHI (0.33 vs. 0.04, p < 0.001. Thirteen of 20 patients showed a pharmacodynamic response, defined as an increase in PVD > 1.8 SD from shock baseline. Hemodynamics and vasoactive doses did not change during the 30-min study period. Our findings suggest a topical nitroglycerin challenge with handheld videomicroscopy can safely assess for localized recruitment of the microcirculatory blood flow in patients with circulatory shock and may be a useful test to identify nitroglycerin responsiveness.
(© 2022. The Author(s).)
Databáze: MEDLINE
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