Evaluation of the sublingual microcirculation in cardiogenic shock.
OBJECTIVE
Orthogonal polarized spectral imaging- and sidestream darkfield-technique have enabled visual evaluation of the microcirculation. Different investigators described microcirculatory alterations, especially in surgical patients suffering from septic shock. We investigated the sublingual microcirculation in non-surgical patients admitted to our medical, intensive care unit (ICU).


METHODS
In 24 severely ill (APACHE-II Score: 27.8+/-11.3), intubated patients admitted to our ICU the sublingual microcirculation was recorded with a handheld intravital microscope. Sublingual vessels were categorized according to their size (small: 10-25 microm; medium: 26-50 microm; large: 51-100 microm) and the flow in semiquantitative categories (0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow).


RESULTS
Patients with cardiogenic shock (n=7) had lower microflow compared with patients without cardiogenic shock (small p<0.001, medium p<0.001, large p=0.003). Several other diseases, including diabetes and arterial hypertension, age, gender, had no influence. In general, patients with a flow less than 3 in the small vessels showed higher arterial blood lactate levels (p=0.043) compared to continuous flow.


CONCLUSIONS
A consequence of cardiogenic shock is the impairment of microcirculation with organ hypoperfusion. We observed that cardiac output is correlated to disturbance in microflow in the smallest vessels. On-line evaluation of microcirculation in vivo may be a valid tool for optimizing therapeutic measures in high risk patients. Additional online material may be found at: http://www.kim1.uniklinik-jena.de/Microcirculation.html.
Jung
Christian
C
Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany. christian.jung@med.uni-jena.de
Ferrari
Markus
M
Rödiger
Christoph
C
Fritzenwanger
Michael
M
Goebel
Bjoern
B
Lauten
Alexander
A
Pfeifer
Ruediger
R
Figulla
Hans R
HR
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007362:Intensive Care Units; D008833:Microcirculation; D018715:Microscopy, Video; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D012039:Regional Blood Flow; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology*