Kiudulaite Inga, Belousoviene Egle, Vitkauskiene Astra, Pranskunas Andrius
Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, 50161, Kaunas, Lithuania.
Department of Laboratory Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania.
Ann Intensive Care. 2021 Apr 7;11(1):55. doi: 10.1186/s13613-021-00848-y.
Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. However, the therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcirculation in patients with sepsis.
This prospective single-arm trial was performed in a mixed ICU at a tertiary teaching hospital. We included patients with sepsis or septic shock within 24 h of ICU admission. The RIC procedure comprised 3 cycles of brachial cuff inflation to 200 mmHg for 5 min followed by deflation to 0 mmHg for another 5 min. The procedure took 30 min. RIC was performed at the time of study inclusion and repeated after 12 and 24 h. Sublingual microcirculatory measurements were obtained before and after each RIC procedure using a Cytocam-incident dark-field (IDF) device (Braedius Medical, Huizen, The Netherlands). The microcirculatory data were compared with a historical control. Data are reported as the medians along with the 25th and 75th percentiles.
Twenty-six septic patients with a median age of 65 (57-81) years were enrolled in this study. The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at admission were 20 (13-23) and 10 (9-12), respectively. All patients were receiving vasopressors. After the 1st RIC procedure, the microvascular flow index (MFI) and the proportion of perfused vessels (PPV) among small vessels were significantly higher than before the procedure, with pre- and post-treatment values of 2.17 (1.81-2.69) and 2.59 (2.21-2.83), respectively, for MFI (p = 0.003) and 87.9 (82.4-93.8) and 92.5 (87.9-96.1) %, respectively, for PPV (p = 0.026). This result was confirmed by comparison with a historical control group. We found no change in microcirculatory flow or density parameters during repeated RIC after 12 h and 24 h.
In patients with sepsis, the first remote ischemic conditioning procedure improved microcirculatory flow, whereas later procedures did not affect sublingual microcirculation. Trial registration NCT04644926, http://www.clinicaltrials.gov . Date of registration: 25 November 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04644926 .
远程缺血预处理（RIC）是一种很有前景的技术，可能保护器官和组织免受额外缺血事件的影响。然而，RIC在脓毒症患者中的治疗效果尚不清楚。我们假设RIC可能改善脓毒症患者的舌下微循环。
这项前瞻性单臂试验在一家三级教学医院的综合重症监护病房（ICU）进行。我们纳入了入住ICU 24小时内的脓毒症或脓毒性休克患者。RIC程序包括3个周期的肱动脉袖带充气至200 mmHg持续5分钟，然后放气至0 mmHg再持续5分钟。该程序耗时30分钟。在研究纳入时进行RIC，并在12小时和24小时后重复。使用Cytocam入射暗场（IDF）设备（荷兰豪曾市Braedius Medical公司）在每次RIC程序前后进行舌下微循环测量。将微循环数据与历史对照组进行比较。数据报告为中位数以及第25和第75百分位数。
本研究纳入了26例脓毒症患者，中位年龄为65（57 - 81）岁。入院时急性生理学与慢性健康状况评估（APACHE）II评分和序贯器官衰竭评估（SOFA）评分的中位数分别为20（13 - 23）和10（9 - 12）。所有患者均接受血管活性药物治疗。在第一次RIC程序后，微血管血流指数（MFI）和小血管中灌注血管的比例（PPV）显著高于程序前，MFI的治疗前和治疗后值分别为2.17（1.81 - 2.69）和2.59（2.21 - 2.83）（p = 0.003），PPV分别为87.9（82.4 - 93.8）%和92.5（87.9 - 96.1）%（p = 0.026）。与历史对照组比较证实了这一结果。我们发现在12小时和24小时重复RIC期间，微循环血流或密度参数没有变化。
在脓毒症患者中，首次远程缺血预处理程序改善了微循环血流，而后续程序未影响舌下微循环。试验注册编号NCT04644926，http://www.clinicaltrials.gov 。注册日期：2020年11月25日。回顾性注册，https://clinicaltrials.gov/ct2/show/NCT04644926 。
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