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Severe Impairment of Microcirculatory Perfused Vessel Density Is Associated With Postoperative Lactate and Acute Organ Injury After Cardiac Surgery.
Metadata
Journaljournal of cardiothoracic and vascular anesthesia2.258Date
2020 May 14
4 months ago
Type
Journal Article
Volume
2020-May-14 / :
Author
Greenwood JC 1, Jang DH 2, Hallisey SD 3, Gutsche JT 4, Horak J 4, Acker MA 5, Bermudez CA 5, Zhou VL 6, Chatterjee S 7, Shofer FS 8, Kilbaugh TJ 9, Augoustides JGT 4, Meyer NJ 10, Bakker J 11, Abella BS 12
Affiliation
  • 2. Division of Medical Toxicology and Critical Care Medicine, Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 3. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
  • 4. Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 5. Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 6. Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
  • 7. Department of Physiology, Institute for Environmental Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 8. Epidemiology and Biostatistics, Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
  • 9. Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Center for Mitochondrial and Epigenomic Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 10. Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • 11. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY; Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Intensive Medicine, The Pontifical Catholic University of Chile.
  • 12. Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Doi
PMIDMESH
Abstract
OBJECTIVE: Resuscitation after cardiac surgery needs to address multiple pathophysiological processes that are associated with significant morbidity and mortality. Functional microcirculatory derangements despite normal systemic hemodynamics have been previously described but must be tied to clinical outcomes. The authors hypothesized that microcirculatory dysfunction after cardiac surgery would include impaired capillary blood flow and impaired diffusive capacity and that subjects with the lowest quartile of perfused vessel density would have an increased postoperative lactate level and acute organ injury scores.
DESIGN: Prospective, observational study.
SETTING: A single, tertiary university cardiovascular surgical intensive care unit.
PARTICIPANTS: 25 adults undergoing elective cardiac surgery requiring cardiopulmonary bypass.
INTERVENTION: Sublingual microcirculation was imaged using incident dark field microscopy before and 2 to 4 hours after surgery in the intensive care unit.
MEASUREMENTS AND MAIN RESULTS: Compared with baseline measurements, postoperative vessel-by-vessel microvascular flow index (2.9 [2.8-2.9] v 2.5 [2.4-2.7], p < 0.0001) and perfused vessel density were significantly impaired (20.7 [19.3-22.9] v 16.3 [12.8-17.9], p < 0.0001). The lowest quartile of perfused vessel density (<12.8 mm/mm2) was associated with a significantly increased postoperative lactate level (6.0 ± 2.9 v 1.8 ± 1.2, p < 0.05), peak lactate level (7.6 ± 2.8 v 2.8 ± 1.5, p = 0.03), and sequential organ failure assessment (SOFA) score at 24 and 48 hours.
CONCLUSION: In patients undergoing cardiac surgery, there was a significant decrease in postoperative microcirculatory convective blood flow and diffusive capacity during early postoperative resuscitation. Severely impaired perfused vessel density, represented by the lowest quartile of distribution, is significantly related to hyperlactatemia and early organ injury.
Keywords: cardiac surgery critical care microcirculation resuscitation shock
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J Cardiothorac Vasc Anesthjournal of cardiothoracic and vascular anesthesia
Metadata
LocationUnited States
FromW B SAUNDERS CO-ELSEVIER INC

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