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. 2014 Dec 4:4:39.
doi: 10.1186/s13613-014-0039-3. eCollection 2014.

Dissociation between sublingual and gut microcirculation in the response to a fluid challenge in postoperative patients with abdominal sepsis

Vanina Siham Kanoore Edul  1 , Can Ince  2 , Noelia Navarro  3 , Luciana Previgliano  3 , Alejandro Risso-Vazquez  3 , Paolo Nahuel Rubatto  3 , Arnaldo Dubin  4
Affiliations

Dissociation between sublingual and gut microcirculation in the response to a fluid challenge in postoperative patients with abdominal sepsis

Vanina Siham Kanoore Edul et al. Ann Intensive Care. .

Abstract

Background: This study was performed to compare intestinal and sublingual microcirculation and their response to a fluid challenge.

Methods: Twenty-two septic patients in the first postoperative day of an intestinal surgery, in which an ostomy had been constructed, were evaluated both before and 20 min after a challenge of 10 mL/kg of 6% hydroxyethylstarch 130/0.4. We measured systemic hemodynamics and sublingual and intestinal microcirculation. Correlations between variables were determined through the Pearson test.

Results: Fluid administration increased the cardiac index (2.6 ± 0.5 vs. 3.3 ± 1.0 L/min/m(2), P < 0.01) and mean arterial blood pressure (68 ± 11 vs. 82 ± 12 mm Hg, P < 0.0001). The sublingual but not the intestinal red blood cell (RBC) velocity increased (912 ± 270 vs. 1,064 ± 200 μm/s, P < 0.002 and 679 ± 379 vs. 747 ± 419 μm/s, P = 0.12, respectively). The sublingual and intestinal perfused vascular density (PVD) did not change significantly (15.2 ± 2.9 vs. 16.1 ± 1.2 mm/mm(2) and 12.3 ± 6.7 vs. 13.0 ± 6.7 mm/mm(2)). We found no correlation between the basal sublingual and intestinal RBC velocities or between their changes in response to the fluid challenge. The individual changes in sublingual RBC velocity correlated with those in cardiac index and basal RBC velocity. Individual changes in intestinal RBC velocity did not correlate with either the cardiac index modifications or the basal RBC velocity. The same pattern was observed with the sublingual and the intestinal PVDs. The sublingual RBC velocities and PVDs were similar between survivors and nonsurvivors. But the intestinal RBC velocities and PVDs were lower in nonsurvivors.

Conclusions: In this series of postoperative septic patients, we found a dissociation between sublingual and intestinal microcirculation. The improvement in the sublingual microcirculation after fluid challenge was dependent on the basal state and the increase in cardiac output. In contrast, the intestinal microcirculation behaved as an isolated territory.

Keywords: Abdominal surgery; Fluid challenge; Intestine; Microcirculation; Septic shock; Sublingual; Tissue perfusion.

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Figures

Figure 1
Figure 1
Red blood cell (RBC) velocity. (A) Correlation between basal sublingual and intestinal RBC velocity. (B) Correlation between the changes in sublingual and intestinal RBC velocities in response to the fluid challenge. (C) Correlation between the changes in cardiac index and sublingual RBC velocity in response to the fluid challenge. (D) Correlation between the changes in sublingual RBC velocity in response to the fluid challenge and the basal sublingual RBC velocity. (E) Correlation between the changes in cardiac index and intestinal RBC velocity in response to the fluid challenge. (F) Correlation between the changes in intestinal RBC velocity in response to the fluid challenge and the basal intestinal RBC velocity.
Figure 2
Figure 2
Perfused vascular density (PVD). (A) Correlation between basal sublingual and intestinal PVD. (B) Correlation between the changes in sublingual and intestinal PVD in response to the fluid challenge. (C) Correlation between the changes in cardiac index and sublingual PVD in response to the fluid challenge. (D) Correlation between the changes in sublingual PVD in response to the fluid challenge and the basal sublingual PVD. (E) Correlation between the changes in cardiac index and intestinal PVD in response to the fluid challenge. (F) Correlation between the changes in intestinal PVD in response to the fluid challenge and the basal intestinal PVD.
Figure 3
Figure 3
Sublingual and intestinal microcirculatory variables in survivor and nonsurvivor patients.
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