Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis.
OBJECTIVE
To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion.


METHODS
Observational, experimental study.


METHODS
University-affiliated large animal laboratory.


METHODS
Ten fasted, anesthetized, mechanically ventilated, male pigs randomized to a sham group (n = 3) or to a hyperdynamic septic shock group (n = 7) in which cholangitis was induced by direct infusion of Escherichia coli into the common bile duct. This model was developed because it is not accompanied by changes in intra-abdominal pressure.


RESULTS
The sublingual and intestinal microcirculations were simultaneously assessed at 4-hr intervals for up to 12 hrs with a modified orthogonal polarization spectral device and functional microvessel density and erythrocyte velocity were measured quantitatively. In sham animals, both regions maintained a stable functional microvessel density and erythrocyte velocity throughout the study period. In contrast, in septic animals, already after 4 hrs of sepsis, functional microvessel density was markedly decreased (>50%) in the sublingual and gut regions; mean erythrocyte velocity decreased dramatically and similarly in both regions, from 1022 +/- 80 to 265 +/- 43 mum/sec in the sublingual region and from 1068 +/- 45 to 243 +/- 115 mum/sec in the gut (p < 0.001, at T12). There was a significant correlation between the sublingual and gut microcirculations in septic animals (r = 0.92, p < 0.0001).


CONCLUSIONS
The severity and the time course of microcirculatory changes were similar in the sublingual and in the gut region in this clinically relevant model of severe sepsis. These findings support the sublingual region as an appropriate region to monitor the microcirculation in sepsis.
Verdant
Colin L
CL
Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium. jlvincen@ulb.ac.be
De Backer
Daniel
D
Bruhn
Alejandro
A
Clausi
Carla M
CM
Su
Fuhong
F
Wang
Zhen
Z
Rodriguez
Hector
H
Pries
Axel R
AR
Vincent
Jean-Louis
JL
D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D002761:Cholangitis / Q000382:microbiology; D004195:Disease Models, Animal; D004912:Erythrocytes / Q000502:physiology; D004927:Escherichia coli Infections / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D007413:Intestinal Mucosa / Q000098:blood supply*; D007422:Intestines / Q000098:blood supply*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008859:Microscopy, Polarization; D055806:Microvessels / Q000473:pathology; D009060:Mouth Floor / Q000098:blood supply*; D009061:Mouth Mucosa / Q000098:blood supply*; D011897:Random Allocation; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000382:microbiology / Q000503:physiopathology*; D013552:Swine