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. 2015 Dec;25(6):347-54.
doi: 10.1007/s10286-015-0286-x. Epub 2015 Aug 18.

Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases

Eva Klijn  1 , Sjoerd Niehof  2 , A B Johan Groeneveld  3 , Alexandre Pinto Lima  3 , Jan Bakker  3 , Jasper van Bommel  3
Affiliations

Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases

Eva Klijn et al. Clin Auton Res. 2015 Dec.

Erratum in

Abstract

Purpose: Microvascular perfusion may be a non-invasive indicator of fluid responsiveness. We aimed to investigate which of the microvascular perfusion parameters truly reflects fluid responsiveness independent of sympathetic reflexes.

Methods: Fifteen healthy volunteers underwent a postural change from head up tilt (HUT) to the supine position, diminishing sympathetic tone, followed by a 30° passive leg raising (PLR) with unaltered tone. Prior to and after the postural changes, stroke volume (SV) and cardiac output (CO) were measured, as well as sublingual microcirculatory perfusion (sidestream dark field imaging), skin perfusion, and oxygenation (laser Doppler flowmetry and reflectance spectroscopy).

Results: In responders (subjects with >10 % increase in CO), the HUT to supine change increased CO, SV, and pulse pressure, while heart rate, systemic vascular resistance, and mean arterial pressure decreased. Additionally, microvascular flow index, laser Doppler flow, and microvascular hemoglobin oxygen saturation and concentration also increased.

Conclusion: When preload and forward flow increase in association with a decrease in sympathetic activity, microvascular blood flow increases in the skin and in the sublingual area. When preload and forward flow increase with little to no change in sympathetic activity, only sublingual functional capillary density increases. Therefore, our results indicate that sublingual functional capillary density is the best parameter to use when evaluating fluid responsiveness independent of changes in sympathetic tone.

Keywords: Cardiac output; Head up tilt; Microcirculation; Passive leg raising; Sympathetic tone.

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Figures

Fig. 1
Fig. 1
Postural changes. The 70° head up tilt (HUT)-to-supine posture change induces a large preload challenge, which redistributes approximately 500 mL of pooled blood to the central circulation. The semi-recumbent position to 30° passive leg raising (PLR) induces a smaller preload challenge, which redistributes approximately 150–300 mL of pooled blood to the central circulation
Fig. 2
Fig. 2
Changes in cardiac output (CO), laser Doppler flow (LDF), and functional capillary density (FCD) during HUT to the supine position and PLR posture change. The upper panel represents the results for the responders and the lower panel for the non-responders. (a P = 0.002, b P = 0.027, c P = 0.003, d P = 0.046). Mean ± standard deviation
See this image and copyright information in PMC

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