Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Translational Physiology, Amsterdam UMC, Amsterdam, The Netherlands.
Department of Translational Physiology, Amsterdam UMC, Amsterdam, The Netherlands; Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
Microvasc Res. 2019 May;123:14-18. doi: 10.1016/j.mvr.2018.11.006. Epub 2018 Nov 16.
Clinical evaluation of the effects of fluid therapy remains cumbersome and strategies are based on the assumption that normalization of macrohemodynamic variables will result in parallel improvement in organ perfusion. Recently, we and others suggested the use of direct in-vivo observation of the microcirculation to evaluate the effects of fluid therapy.
A single-centre observational study, using in-vivo microscopy to assess total vessel density (TVD) in two subsets of ICU patients.
After fluid resuscitation TVD showed no difference between sepsis patients (N = 47) and cardiac surgery patients (N = 52): 18.4[16.8-20.8] vs 18.7[16.8-20.9] mm/mm, p = 0.59. In cardiac surgery patients there was a significant correlation between the amount of fluids administered and TVD, with an optimum in the third quartile. However, such correlation was absent in septic patients.
TVD after fluid administration is not different between 2 subtypes of intensive care patients. However, only in septic patients we observed a lack of coherence between the amount of fluids administered and TVD. Further research is needed to determine if TVD may serve as potential endpoint for fluid administration.
液体治疗效果的临床评估仍然繁琐，策略基于这样的假设，即宏观血流动力学变量的正常化将导致器官灌注的平行改善。最近，我们和其他人建议使用直接活体观察微循环来评估液体治疗的效果。
一项单中心观察性研究，使用活体显微镜评估 ICU 患者的两个亚组的总血管密度（TVD）。
液体复苏后，TVD 在脓毒症患者（N=47）和心脏手术患者（N=52）之间没有差异：18.4[16.8-20.8] vs 18.7[16.8-20.9] mm/mm，p=0.59。在心脏手术患者中，给予的液体量与 TVD 之间存在显著相关性，第三四分位数时达到最佳。然而，在脓毒症患者中，这种相关性不存在。
液体治疗后，两种类型的重症监护患者的 TVD 没有差异。然而，只有在脓毒症患者中，我们观察到给予的液体量与 TVD 之间缺乏一致性。需要进一步研究以确定 TVD 是否可以作为液体给药的潜在终点。
