title: Sublingual microcirculation in patients with intra-abdominal hypertension: a pilot study in 15 critically ill patients.
abstract: OBJECTIVE
  The purpose of the study is to clarify whether increased intra-abdominal pressure (IAP) is associated with sublingual microcirculatory alterations in intensive care patients.
  
  
  METHODS
  Fifteen adult, mechanically ventilated patients were included if their IAP was at least 12 mm Hg for at least 12 hours within the first 3 days after admission to the intensive care unit. Sublingual sidestream dark field (SDF) images were recorded twice a day for 7 days.
  
  
  RESULTS
  Median (interquartile range) IAP at inclusion was 14.5 (12.5-16.0) mm Hg. The total vascular density of small vessels at the sublingual area was 13.1 (10.6-14.3) per square millimeter at baseline; the proportion of perfused vessels, 78.9% (69.6%-86.2%); and perfused vessels density, 12.4 (10.8-13.8) per square millimeter. The calculated indices suggested relatively good blood flow in the capillaries, with a De Backer score of 9.0 (8.3-10.2) and a microvascular blood flow of 3.0 (2.9-3.0). Blood flow heterogeneity index was 0.3 (0.1-0.5) at study entry. Despite that IAP, vasopressors dose, and arterial lactate decreased significantly over time, no significant changes were observed in sublingual microvascular density or blood flow. Weak correlations of microvascular blood flow (positive) and heterogeneity index (negative) were detected with both mean arterial pressure and abdominal perfusion pressure.
  
  
  CONCLUSIONS
  Neither grade I or II intra-abdominal hypertension (IAP from 12 to 18 mm Hg) is associated with significant changes of sublingual microcirculation in intensive care patients. Correlation analysis indicates better microvascular blood flow at higher mean arterial pressure and abdominal perfusion pressure levels.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia. Electronic address: liivi.maddison@kliinikum.ee.
authors.forename: Liivi
authors.initials: L
authors.lastname: Maddison
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Juri
authors.initials: J
authors.lastname: Karjagin
authors.affiliation: University of Tartu, Medical Faculty, Ravila 19, Tartu, Estonia.
authors.forename: Maksim
authors.initials: M
authors.lastname: Buldakov
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Merilin
authors.initials: M
authors.lastname: Mäll
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Rein
authors.initials: R
authors.lastname: Kruusat
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Kadri
authors.initials: K
authors.lastname: Lillemäe
authors.affiliation: Department of Surgery, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Ulle
authors.initials: U
authors.lastname: Kirsimägi
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D016638:Critical Illness; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology*; D008833:Microcirculation / Q000502:physiology*; D009060:Mouth Floor / Q000098:blood supply*; D010865:Pilot Projects; D012121:Respiration, Artificial
keywords: Critically ill patients; Intra-abdominal hypertension; Intra-abdominal pressure; Sidestream dark field imaging; Sublingual microcirculation