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. 2012 Jul;30(6):872-80.
doi: 10.1016/j.ajem.2011.06.005. Epub 2011 Aug 25.

Sublingual tissue perfusion improves during emergency treatment of acute decompensated heart failure

Christopher J Hogan  1 , Kevin R Ward, Douglas S Franzen, Bipin Rajendran, Leroy R Thacker
Affiliations

Sublingual tissue perfusion improves during emergency treatment of acute decompensated heart failure

Christopher J Hogan et al. Am J Emerg Med. 2012 Jul.

Abstract

Objectives: The aim of this study was to measure sublingual perfused capillary density (PCD) to assess sublingual microvascular perfusion during emergency department (ED) treatment of acute decompensated heart failure (ADHF).

Methods: This prospective, observational study enrolled ED patients with ADHF, measuring pre- and post-ED treatment PCD. Sidestream dark-field imaging was analyzed by 3 investigators blinded to patient identifiers and time points. Patient demographics, ADHF etiology, serum brain natriuretic peptide, and hemoglobin were measured along with a visual analogue scale (VAS), which assessed patient baseline characteristics and response to ED treatment. A paired t test analyzed changes in PCD, mean arterial pressure (MAP), and patient assessment. Interrater variability was assessed with an intraclass correlation coefficient (ICC), with a P value <.05 considered significant for all testing.

Results: Thirty-six patients were enrolled with a mean time between pretreatment and posttreatment PCD (±SD) of 138 ± 59 minutes and a hospital length of stay of 4.0 ± 4.1 days. During this time, PCD increased (difference, 1.3 mm/mm(2); 95% confidence interval, 0.4-2.1; P = .004), as did the MAP (P = .002), patient VAS score (P < .001), and observer VAS score (P < .001). There was no correlation between the change in PCD and time (R(2) = .016, P = .47), MAP (R(2) = .013, P = .54), or VAS scores. The ICC was 0.954.

Conclusions: Sublingual tissue perfusion is diminished in ADHF but increases with treatment. It may represent a quantitative way to evaluate ADHF in the ED setting.

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Figures

Figure 1
Figure 1
Sidestream darkfield imaging in acute decompensated heart failure, ranging from larger venules and arterioles to smaller capillaries in which single file erythrocytes move through sublingual tissue.
Figure 2
Figure 2
The pre- and post-treatment perfused capillary density measurement distributions, with the median denoted by the horizontal bar, and the 25th and 75th interquartile ranges represented by the lower and upper boundaries of the rectangle, respectively.
Figure 3
Figure 3
Pre- and post-treatment perfused capillary density (PCD) with standard error in patients undergoing ED treatment of acute decompensated heart failure (ADHF). The change from pre- to post-treatment PCD is shown for each patient.
Figure 4
Figure 4
The change from pre- to post-treatment perfused capillary density (PCD) for each patient undergoing ED treatment of acute decompensated heart failure (ADHF).
Figure 5
Figure 5
Bivariate fit (R2 = 0.016, p = 0.47) of change from pre- and post-treatment PCD (Delta PCD) by time between measurements (ED Time).
Figure 6
Figure 6
Bivariate fit (R2 = 0.013, p = 0.54) of change from pre- and post-treatment PCD (Delta PCD) by pre- and post-treatment mean arterial pressure measurements (Delta MAP).
Figures 7a and 7b
Figures 7a and 7b
Bivariate fits of the patient-scored (Delta PT VAS) visual analogue scale score (R2 = 0.09, p = 0.09) and the observer-scored (Delta OBS VAS) visual analogue scale score (R2 = 0.04, p = 0.26) versus the change in perfused capillary density (Delta SDI) over the treatment period.
See this image and copyright information in PMC

Comment in

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