Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study

Autor: Claudia Scorcella, Elisa Damiani, Abele Donati, Roberta Domizi, Sara Vannicola, Sandra Bolognini, Andrea Carsetti, Simona Pantanetti, Vincenzo Gabbanelli, R Castagnani
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Physiology
Organ Dysfunction Scores
Blood Pressure
030204 cardiovascular system & hematology
Cardiovascular Physiology
Pathology and Laboratory Medicine
Biochemistry
Vascular Medicine
Norepinephrine
0302 clinical medicine
Spectrum Analysis Techniques
Catecholamines
Medicine and Health Sciences
Prospective Studies
Amines
Prospective cohort study
Multidisciplinary
Spectroscopy
Near-Infrared
Organic Compounds
near-Infrared Spectroscopy
Neurochemistry
Neurotransmitters
Hematology
Middle Aged
Hospitals
Systemic Inflammatory Response Syndrome
Chemistry
Intensive Care Units
Blood Circulation
Physical Sciences
Cardiology
Medicine
SOFA score
Female
medicine.symptom
Perfusion
Research Article
Chemical Elements
Adult
medicine.medical_specialty
Biogenic Amines
Critical Illness
Multiple Organ Failure
Science
Infrared Spectroscopy
Research and Analysis Methods
Vascular occlusion
Microcirculation
03 medical and health sciences
Signs and Symptoms
Oxygen Consumption
Diagnostic Medicine
Intensive care
Internal medicine
Sepsis
medicine
Humans
Mouth Floor
Aged
Retrospective Studies
business.industry
Organ dysfunction
Organic Chemistry
Chemical Compounds
Hemodynamics
Biology and Life Sciences
030208 emergency & critical care medicine
Hormones
Oxygen
Health Care
Health Care Facilities
Wounds and Injuries
business
Neuroscience
Zdroj: PLoS ONE, Vol 14, Iss 3, p e0213085 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: Introduction Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma. Materials and methods This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected. Results Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA. Discussion In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
Databáze: OpenAIRE
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