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Review
. 2023 Sep 29:11:1123405.
doi: 10.3389/fped.2023.1123405. eCollection 2023.

End organ perfusion and pediatric microcirculation assessment

Grace M Arteaga  1 , Sheri Crow  1
Affiliations
Review

End organ perfusion and pediatric microcirculation assessment

Grace M Arteaga et al. Front Pediatr. .

Abstract

Cardiovascular instability and reduced oxygenation are regular perioperative critical events associated with anesthesia requiring intervention in neonates and young infants. This review article addresses the current modalities of assessing this population's adequate end-organ perfusion in the perioperative period. Assuring adequate tissue oxygenation in critically ill infants is based on parameters that measure acceptable macrocirculatory hemodynamic parameters such as vital signs (mean arterial blood pressure, heart rate, urinary output) and chemical parameters (lactic acidosis, mixed venous oxygen saturation, base deficit). Microcirculation assessment represents a promising candidate for assessing and improving hemodynamic management strategies in perioperative and critically ill populations. Evaluation of the functional state of the microcirculation can parallel improvement in tissue perfusion, a term coined as "hemodynamic coherence". Less information is available to assess microcirculatory disturbances related to higher mortality risk in critically ill adults and pediatric patients with septic shock. Techniques for measuring microcirculation have substantially improved in the past decade and have evolved from methods that are limited in scope, such as velocity-based laser Doppler and near-infrared spectroscopy, to handheld vital microscopy (HVM), also referred to as videomicroscopy. Available technologies to assess microcirculation include sublingual incident dark field (IDF) and sublingual sidestream dark field (SDF) devices. This chapter addresses (1) the physiological basis of microcirculation and its relevance to the neonatal and pediatric populations, (2) the pathophysiology associated with altered microcirculation and endothelium, and (3) the current literature reviewing modalities to detect and quantify the presence of microcirculatory alterations.

Keywords: children; critically ill; hemodynamic; microcirculation; neonate; videomicroscopy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Microvasculature: (A) pericytes surround and support the capillaries, the most numerous and dynamic component of the microcirculation where gas and metabolite exchange occurs, and postcapillary venules, where endothelial cells lack tight junctions and are leakier than capillaries. (B) Representation of two endothelial cells joined transversally to maintain intact endothelium. (C) Cross sectional view of the microcirculation with red blood cells circulating in the inner section (D) Graphic representation of the glycocalyx covering the endothelial cells lining the blood vessel. The membrane bound main components include proteoglycans (syndecans, glypicans), glycoproteins (selectins, integrins). The endothelial surface layer includes hyaluronan, plasma proteins, and soluble proteoglycans. Shedding of endothelial glycocalyx (EG) components into the plasma is related to different critically ill conditions, potentially indicating the degree of endotheliopathy.
Figure 2
Figure 2
Flow diagram and selection of eligible manuscripts included in this report.
Figure 3
Figure 3
Schematic diagram proposing the evaluation of macro and micro circulations in the pediatric clinical assessment.
See this image and copyright information in PMC

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