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Observational Study
. 2019 Mar 5;14(3):e0213085.
doi: 10.1371/journal.pone.0213085. eCollection 2019.

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

Roberta Domizi  1 , Elisa Damiani  1 , Claudia Scorcella  1 , Andrea Carsetti  1 , Roberta Castagnani  1 , Sara Vannicola  1 , Sandra Bolognini  1 , Vincenzo Gabbanelli  1 , Simona Pantanetti  1 , Abele Donati  1
Affiliations
Observational Study

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

Roberta Domizi et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Changes in the sublingual microvascular parameters in the first 4 days of admission in ICU for the two groups of patients (SOFA score at D4≤6.5 and SOFA score at D4>6.5). * p<0.05; ** p<0.01.
TVDs: total small vessel density; PVDs: perfused small vessel density; MFI: microvascular flow index; PPV: percentage of perfused vessels.
Fig 2
Fig 2. Changes in NIRS-derived parameters in the first 4 days of admission in ICU for the two groups of patients (SOFA score at D4≤6.5 and SOFA score at D4>6.5). * p<0.05.
StO2: tissue oxygen saturation; AUC StO2: area under the curve of tissue oxygen saturation.
Fig 3
Fig 3. Receiver Operating Characteristic (ROC) curves. Discriminative ability of PVDs and TVDs (on the left) and StO2 downslope and upslope (on the right) at admission in ICU towards D4 SOFA score.
TVDs: total small vessel density; PVDs: perfused small vessel density. StO2: tissue oxygen saturation.
See this image and copyright information in PMC

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