Sturm Timo, Leiblein Julia, Clauß Christoph, Erles Enno, Thiel Manfred
Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
TRACC-Group (Translational Research in Anaesthesiology and Critical Care), Mannheim, Germany.
Sci Rep. 2021 Dec 31;11(1):24516. doi: 10.1038/s41598-021-03922-4.
Assessment of microcirculatory functional capacity is considered to be of prime importance for therapy guidance and outcome prediction in critically ill intensive care patients. Here, we show determination of skin microcirculatory oxygen delivery and consumption rates to be a feasible approach at the patient's bedside. Real time laser-doppler flowmetry (LDF) and white light spectrophotometry (WLS) were used for assessment of thenar skin microperfusion, regional Hb and postcapillary venous oxygen saturation before and after forearm ischemia. Adapted Fick's principle equations allowed for calculation of microcirculatory oxygen delivery and uptake. Patient groups with expected different microcirculatory status were compared [control (n = 20), sepsis-1/2 definition criteria identified SIRS (n = 10) and septic shock patients (n = 20), and the latter group further classified according to sepsis-3 definition criteria in sepsis (n = 10) and septic shock (n = 10)], respectively. In otherwise healthy controls, microcirculatory oxygen delivery and uptake approximately doubled after ischemia with maximum values (mDO2max and mVO2max) significantly lower in SIRS or septic patient groups, respectively. Scatter plots of mVO2max and mDO2max values defined a region of unphysiological low values not observed in control but in critically ill patients with the percentage of dots within this region being highest in septic shock patients. LDF and WLS combined with vasoocclusive testing reveals significant differences in microcirculatory oxygen delivery and uptake capacity between control and critically ill patients. As a clinically feasible technique for bedside determination of microcirculatory oxygen delivery and uptake, LDF and WLS combined with vasoocclusive testing holds promise for monitoring of disease progression and/or guidance of therapy at the microcirculatory level to be tested in further clinical trials.ClinicalTrials.gov: NCT01530932.
评估微循环功能能力被认为对重症监护患者的治疗指导和预后预测至关重要。在此，我们表明在患者床边测定皮肤微循环氧输送和消耗率是一种可行的方法。使用实时激光多普勒血流仪（LDF）和白光分光光度法（WLS）评估前臂缺血前后大鱼际皮肤微灌注、局部血红蛋白和毛细血管后静脉血氧饱和度。改编后的菲克原理方程可用于计算微循环氧输送和摄取。比较了预期微循环状态不同的患者组[对照组（n = 20）、符合脓毒症-1/2定义标准的全身炎症反应综合征（SIRS）患者（n = 10）和感染性休克患者（n = 20），后一组根据脓毒症-3定义标准进一步分为脓毒症组（n = 10）和感染性休克组（n = 10）]。在其他方面健康的对照组中，缺血后微循环氧输送和摄取量分别增加了约一倍，而SIRS或脓毒症患者组的最大值（mDO2max和mVO2max）明显较低。mVO2max和mDO2max值的散点图定义了一个非生理性低值区域，该区域在对照组中未观察到，但在重症患者中存在，脓毒性休克患者中该区域内的点百分比最高。LDF和WLS结合血管闭塞试验显示，对照组和重症患者之间在微循环氧输送和摄取能力方面存在显著差异。作为一种用于床边测定微循环氧输送和摄取的临床可行技术，LDF和WLS结合血管闭塞试验有望在进一步的临床试验中用于监测疾病进展和/或在微循环水平指导治疗。ClinicalTrials.gov：NCT01530932。
