title: Side-by-Side Alterations in Glycocalyx Thickness and Perfused Microvascular Density During Acute Microcirculatory Alterations in Cardiac Surgery.
abstract: OBJECTIVE
  Endothelial glycocalyx injury causes microcirculatory perfusion disturbances in experimental studies, but the relevance in a clinical setting remains unknown. We investigated whether glycocalyx dimensions are reduced after onset of CPB and whether this is associated with alterations in microvascular perfusion.
  
  
  METHODS
  The current observational study included 36 patients undergoing cardiac surgery without or with CPB, using either nonpulsatile or pulsatile flow. Sublingual microcirculatory perfusion was assessed perioperatively and analyzed for perfused vessel density and PBR, an inverse parameter of endothelial glycocalyx dimensions.
  
  
  RESULTS
  Perfused vessel density decreased after onset of CPB in parallel with an increase in PBR in both pulsatile and nonpulsatile groups. In the nonpulsatile CPB group, these alterations were still persistent in the ICU (PVD: T1 19.8 ± 2.8 mm/mm(2) vs. T3 15.3 ± 2.6 mm/mm(2) ; p = 0.004. PBR: T1 2.40 ± 0.35 μm vs. T3 2.60 ± 0.31 μm; p = 0.020). In the off-pump group, perfused vessel density remained unaltered. An inverse correlation between perfused vessel density and PBR was detected.
  
  
  CONCLUSIONS
  This study shows that endothelial glycocalyx dimensions decrease after onset of CPB and are closely related to microvascular perfusion when assessed with a novel, noninvasive technique.
authors.affiliation: Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Koning
authors.affiliation: Department of Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Alexander B A
authors.initials: AB
authors.lastname: Vonk
authors.affiliation: Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Vink
authors.affiliation: Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D019276:Glycocalyx / Q000378:metabolism*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply / Q000378:metabolism; D010477:Perfusion
keywords: capillaries; cardiopulmonary bypass; endothelial glycocalyx; microcirculation