Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis.
OBJECTIVE
To evaluate the relation between sublingual and intestinal microcirculatory alterations in patients with abdominal sepsis.


METHODS
Prospective observational study.


METHODS
A 23-bed mixed intensive care unit of a tertiary teaching hospital.


METHODS
Twenty-three patients with abdominal sepsis and a newly constructed intestinal stoma were included in the study group. Nineteen outpatient healthy individuals with an intestinal stoma and ten nonsepsis patients with a <24-hr-old intestinal stoma were included as controls.


METHODS
None.


RESULTS
Orthogonal polarization spectral imaging of the sublingual and intestinal microcirculation was performed on days 1 and 3. In addition, variables of systemic hemodynamics, such as cardiac index, heart rate, blood pressure, central venous pressure, and dosages of vasopressor and inotropic agents, were obtained. On day 1 there was no correlation of the microvascular flow index between the sublingual and intestinal microcirculatory beds (Spearman's rho [rs] = .12; 95% confidence interval, -.51 to .31; p = .59). Furthermore, there was no significant correlation between microcirculatory alterations and variables of systemic circulation (rs <or= .25). On day 3, however, a correlation between sublingual and intestinal microcirculatory flow appeared to be restored (rs = .74; 95% confidence interval, .28-.92; p = .006), mainly due to a normalization of flow in both regions.


CONCLUSIONS
On day 1 of abdominal sepsis there is a complete dispersion of flow, not only between hemodynamic compartments of a different order but also between the sublingual and intestinal microcirculation. Over time, both sublingual and intestinal microvascular flow indexes trended to normal values.
Boerma
E Christiaan
EC
Department of Physiology, Academic Medical Center, University of Amsterdam, The Netherlands.
van der Voort
Peter H J
PH
Spronk
Peter E
PE
Ince
Can
C
D000005:Abdomen; D000368:Aged; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007422:Intestines / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D054047:Surgical Stomas