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Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management

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Perioperative Fluid Management

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Abstract

Microcirculatory alterations often occur in the perioperative setting under the influence of multiple factors including hypovolemia, impaired cardiac function, vasoplegia, anesthetic agents, surgical trauma, ischemia/reperfusion injury, and sepsis. The severity and duration of these alterations have been related to the outcome of these patients. This systematic review will report to which extent these microvascular abnormalities can be affected by fluid administration.

Administration of fluids usually improves microvascular dysfunction by increasing the perfused capillary density. Importantly, there is a significant variability among the patients. Timing of the intervention has a huge impact, as early interventions often lead to an improved microvascular perfusion, while delayed intervention often fails to improve the microcirculation. Of note, the impact of fluids on the microcirculation is relatively dissociated from its systemic effects and can thus not be predicted by changes in cardiac output or blood pressure. Changes in lactate or in venoarterial PCO2 gradients can be useful to indirectly evaluate the microvascular effects of fluids. Even though colloids are often associated with greater effects than crystalloids in experimental settings, this has not been confirmed in patients. Finally, the impact of red blood cell transfusions is highly variable and may depend on the severity of microvascular alterations at baseline.

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References

  1. Jhanji S, Lee C, Watson D, Hinds C, Pearse RM. Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med. 2009;35(4):671–7.

    Article  PubMed  Google Scholar 

  2. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98–104.

    Article  PubMed  Google Scholar 

  3. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34(2):403–8.

    Article  PubMed  Google Scholar 

  4. Edul VS, Ince C, Vazquez AR, Rubatto PN, Espinoza ED, Welsh S, et al. Similar microcirculatory alterations in patients with normodynamic and hyperdynamic septic shock. Ann Am Thorac Soc. 2016;13(2):240–7.

    PubMed  Google Scholar 

  5. Verdant CL, De Backer D, Bruhn A, Clausi C, Su F, Wang Z, et al. Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis. Crit Care Med. 2009;37:2875–81.

    Article  PubMed  Google Scholar 

  6. Farquhar I, Martin CM, Lam C, Potter R, Ellis CG, Sibbald WJ. Decreased capillary density in vivo in bowel mucosa of rats with normotensive sepsis. J Surg Res. 1996;61:190–6.

    Article  CAS  PubMed  Google Scholar 

  7. Secor D, Li F, Ellis CG, Sharpe MD, Gross PL, Wilson JX, et al. Impaired microvascular perfusion in sepsis requires activated coagulation and P-selectin-mediated platelet adhesion in capillaries. Intensive Care Med. 2010;36:1928–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Humer MF, Phang PT, Friesen BP, Allards MF, Goddard CM, Walley KR. Heterogeneity of gut capillary transit times and impaired gut oxygen extraction in endotoxemic pigs. J Appl Physiol. 1996;81:895–904.

    CAS  PubMed  Google Scholar 

  9. Koch M, De Backer D, Vincent JL, Barvais L, Hennart D, Schmartz D. Effects of propofol on human microcirculation. Br J Anaesth. 2008;101(4):473–8.

    Article  CAS  PubMed  Google Scholar 

  10. De Backer D, Dubois MJ, Schmartz D, Koch M, Ducart A, Barvais L, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg. 2009;88(5):1396–403.

    Article  PubMed  Google Scholar 

  11. Tachon G, Harrois A, Tanaka S, Kato H, Huet O, Pottecher J, et al. Microcirculatory alterations in traumatic hemorrhagic shock. Crit Care Med. 2014;42(6):1433–41.

    Article  PubMed  Google Scholar 

  12. Lipowsky HH, Firrel JC. Microvascular hemodynamics during systemic hemodilution and hemoconcentration. Am J Physiol. 1986;250:H908–22.

    CAS  PubMed  Google Scholar 

  13. Cabrales P, Martini J, Intaglietta M, Tsai AG. Blood viscosity maintains microvascular conditions during normovolemic anemia independent of blood oxygen-carrying capacity. Am J Physiol Heart Circ Physiol. 2006;291(2):H581–90.

    Article  CAS  PubMed  Google Scholar 

  14. Vellinga NA, Ince C, Boerma EC. Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis. BMC Anesthesiol. 2013;13(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bemelmans RH, Boerma EC, Barendregt J, Ince C, Rommes JH, Spronk PE. Changes in the volume status of haemodialysis patients are reflected in sublingual microvascular perfusion. Nephrol Dial Transplant. 2009;24:3487–92.

    Article  PubMed  Google Scholar 

  16. Hoffmann JN, Vollmar B, Laschke MW, Inthorn D, Schildberg FW, Menger MD. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia. Anesthesiology. 2002;97(2):460–70.

    Article  CAS  PubMed  Google Scholar 

  17. de Carvalho H, Dorigo D, Bouskela E. Effects of Ringer-acetate and Ringer-dextran solutions on the microcirculation after LPS challenge: observations in the hamster cheek pouch. Shock. 2001;15:157–62.

    Article  PubMed  Google Scholar 

  18. Futier E, Christophe S, Robin E, Petit A, Pereira B, Desbordes J, et al. Use of near-infrared spectroscopy during a vascular occlusion test to assess the microcirculatory response during fluid challenge. Crit Care. 2011;15(5):R214.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Buchele G, Simion D, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med. 2010;36(6):949–55.

    Article  PubMed  Google Scholar 

  20. Pottecher J, Deruddre S, Teboul JL, Georger J, Laplace C, Benhamou D, et al. Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med. 2010;36:1867–74.

    Article  PubMed  Google Scholar 

  21. Klijn E, van Velzen MH, Lima AP, Bakker J, van Bommel J, Groeneveld AB. Tissue perfusion and oxygenation to monitor fluid responsiveness in critically ill, septic patients after initial resuscitation: a prospective observational study. J Clin Monit Comput. 2015;29(6):707–12.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pranskunas A, Koopmans M, Koetsier PM, Pilvinis V, Boerma EC. Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy. Intensive Care Med. 2013;39(4):612–9.

    Article  CAS  PubMed  Google Scholar 

  23. Klijn E, Niehof S, Groeneveld AB, Lima AP, Bakker J, van Bommel J. Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases. Clin Auton Res. 2015;25(6):347–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vallee F, Mateo J, Dubreuil G, Poussant T, Tachon G, Ouanounou I, et al. Cutaneous ear lobe PCO2 at 37{degrees}C to evaluate micro perfusion in septic patients. Chest. 2010;138(5):1062–70.

    Article  PubMed  Google Scholar 

  25. Creteur J, De Backer D, Sakr Y, Koch M, Vincent JL. Sublingual capnometry tracks microcirculatory changes in septic patients. Intensive Care Med. 2006;32(4):516–23.

    Article  PubMed  Google Scholar 

  26. Ospina-Tascon GA, Umana M, Bermudez WF, Bautista-Rincon DF, Valencia JD, Madrinan HJ, et al. Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock? Intensive Care Med. 2016;42(2):211–21.

    Article  CAS  PubMed  Google Scholar 

  27. Edul VS, Ince C, Navarro N, Previgliano L, Risso-Vazquez A, Rubatto PN, et al. Dissociation between sublingual and gut microcirculation in the response to a fluid challenge in postoperative patients with abdominal sepsis. Ann Intensive Care. 2014;4:39.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Legrand M, Bezemer R, Kandil A, Demirci C, Payen D, Ince C. The role of renal hypoperfusion in development of renal microcirculatory dysfunction in endotoxemic rats. Intensive Care Med. 2011;37(9):1534–42.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Horstick G, Lauterbach M, Kempf T, Ossendorf M, Kopacz L, Heimann A, et al. Plasma protein loss during surgery: beneficial effects of albumin substitution. Shock. 2001;16(1):9–14.

    Article  CAS  PubMed  Google Scholar 

  30. Ngo AT, Jensen LJ, Riemann M, Holstein-Rathlou NH, Torp-Pedersen C. Oxygen sensing and conducted vasomotor responses in mouse cremaster arterioles in situ. Pflugers Arch. 2010;460(1):41–53.

    Article  CAS  PubMed  Google Scholar 

  31. Horstick G, Lauterbach M, Kempf T, Bhakdi S, Heimann A, Horstick M, et al. Early albumin infusion improves global and local hemodynamics and reduces inflammatory response in hemorrhagic shock. Crit Care Med. 2002;30(4):851–5.

    Article  CAS  PubMed  Google Scholar 

  32. Steinbauer M, Guba M, Buchner M, Farkas S, Anthuber M, Jauch KW. Impact of polynitroxylated albumin (PNA) and tempol on ischemia/reperfusion injury: intravital microscopic study in the dorsal skinfold chamber of the Syrian golden hamster. Shock. 2000;14:163–8.

    Article  CAS  PubMed  Google Scholar 

  33. Dubin A, Pozo MO, Casabella CA, Murias G, Palizas Jr F, Moseinco MC, et al. Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients. J Crit Care. 2010;25:659.e1–8.

    Article  Google Scholar 

  34. Fenton BM, Carr RT, Cokelet GR. Nonuniform red cell distribution in 20 to 100 micrometers bifurcations. Microvasc Res. 1985;29(1):103–26.

    Article  CAS  PubMed  Google Scholar 

  35. Kerger H, Waschke KF, Ackern KV, Tsai AG, Intaglietta M. Systemic and microcirculatory effects of autologous whole blood resuscitation in severe hemorrhagic shock. Am J Physiol. 1999;276:H2035–43.

    CAS  PubMed  Google Scholar 

  36. Gonzalez AM, Yazici I, Kusza K, Siemionow M. Effects of fresh versus banked blood transfusions on microcirculatory hemodynamics and tissue oxygenation in the rat cremaster model. Surgery. 2007;141(5):630–9.

    Article  PubMed  Google Scholar 

  37. Sakr Y, Chierego M, Piagnerelli M, Verdant C, Dubois MJ, Koch M, et al. Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med. 2007;35(7):1639–44.

    Article  PubMed  Google Scholar 

  38. Donati A, Damiani E, Luchetti MM, Domizi R, Scorcella C, Carsetti A, et al. Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in septic patients: a pilot study. Crit Care. 2014;18(1):R33.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sadaka F, Aggu-Sher R, Krause K, O’Brien J, Armbrecht ES, Taylor RW. The effect of red blood cell transfusion on tissue oxygenation and microcirculation in severe septic patients. Ann Intensive Care. 2011;1(1):46.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Yuruk K, Almac E, Bezemer R, Goedhart P, de Mol B, Ince C. Blood transfusions recruit the microcirculation during cardiac surgery. Transfusion. 2011;51(5):961–7.

    Article  PubMed  Google Scholar 

  41. Ayhan B, Yuruk K, Koene S, Sahin A, Ince C, Aypar U. The effects of non-leukoreduced red blood cell transfusions on microcirculation in mixed surgical patients. Transfus Apher Sci. 2013;49(2):212–22.

    Article  PubMed  Google Scholar 

  42. Walsh TS, McArdle F, McLellan SA, Maciver C, Maginnis M, Prescott RJ, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med. 2004;32(2):364–71.

    Article  PubMed  Google Scholar 

  43. Lacroix J, Hebert PC, Fergusson DA, Tinmouth A, Cook DJ, Marshall JC, et al. Age of transfused blood in critically ill adults. N Engl J Med. 2015;372(15):1410–8.

    Article  CAS  PubMed  Google Scholar 

  44. De Backer D, Donadello K, Sakr Y, Ospina-Tascon GA, Salgado DR, Scolletta S, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013;41(3):791–9.

    Article  PubMed  Google Scholar 

  45. De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, et al. How to evaluate the microcirculation: report of a round table conference. Crit Care. 2007;11(5):R101.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tanaka S, Harrois A, Nicolai C, Flores M, Hamada S, Vicaut E, et al. Qualitative real-time analysis by nurses of sublingual microcirculation in intensive care unit: the MICRONURSE study. Crit Care. 2015;19:388.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Braine L’Alleud, Brussels, Belgium

    Daniel De Backer MD, PhD

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  1. Daniel De Backer MD, PhD
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Correspondence to Daniel De Backer MD, PhD .

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Editors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine Director of Clinical Research Staff Anesthesiologist General Anesthesia and Outcomes Research Cleveland Clinic, Cleveland, Ohio, USA

    Ehab Farag

  2. Cleveland Clinic Lerner College of Medicine Chairman of General Anesthesia Cleveland Clinic, Cleveland, Ohio, USA

    Andrea Kurz

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De Backer, D. (2016). Microcirculatory Blood Flow as a New Tool for Perioperative Fluid Management. In: Farag, E., Kurz, A. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-319-39141-0_6

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  • DOI: https://doi.org/10.1007/978-3-319-39141-0_6

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-39141-0

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