Precision real-time evaluation of bowel perfusion: accuracy of confocal endomicroscopy assessment of stoma in a controlled hemorrhagic shock model.
Confocal laser endomicroscopy (CLE) can provide real-time evaluation of bowel perfusion. We aimed to evaluate CLE perfusion imaging in a hemorrhagic shock model.



Five pigs were equipped to ensure hemodynamic monitoring. Three ileostomies per animal (total n = 15) were randomly created (T0). Blood was withdrawn targeting a mean arterial pressure of 40 mmHg (shock phase, T1), for 90 min. Infusion of Ringer's lactate was started and continued for 90 min (T2). At the different time points: (a) stomas' mucosa was scanned with CLE; (b) capillary lactates were measured on blood obtained by puncturing stomas' mucosa; and (c) full-thickness stomas' biopsies were sampled for histology, mitochondrial respiratory rate (V0= basal and VADP= respiratory rate in excess of adenosine diphosphate), and levels of superoxide anion evaluation. Functional capillary density (FCD) was measured using ad hoc software.



Confocal scanning provided consistent and specific imaging of bowel hypoperfusion at T1: vascular hyperpermeability (blurred and enlarged capillaries) and edema (enhanced visualization of the brush border due to increased intercellular spaces and fluorescein leakage). At the end of T2, there was an improved capillary flow. FCD-A index expressed statistically significant correlation with (1) stoma capillary lactates (p = 0.023); (2) systemic capillary lactates (p = 0.031); (3) inflammation pathology score (p = 0.048); (4) central venous pressure (p = 0.0043); and (5) pulmonary artery pressure (p = 0.01). Stoma capillary lactates (mmol/L) were significantly increased at T1 (8.81 ± 4.23; p < 0.0001) and at T2 (4.77 ± 3.13; p < 0.01) when compared to T0 inclusion values (1.86 ± 0.56). V0and VADP(pmol O2/min/mg tissue) were both significantly decreased at T1 versus T0 (p < 0.007 and p < 0.01, respectively) and recovered by the end of reanimation (T2 vs. T0, p = n.s.). Mean O2·-production (µmol/min/mg/dry tissue) increased at T1 and significantly decreased at T2.



Confocal laser endomicroscopy (CLE) imaging could identify morphological signs congruent with biochemical markers of bowel perfusion and could be useful for assessment of stomas.
IHU-Strasbourg, Institute for Minimally Invasive Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, France. michele.diana@ircad.fr.|EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France. michele.diana@ircad.fr.|Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France. michele.diana@ircad.fr.
Michele
0000-0002-1390-8486
M
Diana
Department of Anesthesiology, University Hospital of Strasbourg, Strasbourg, France.|EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
Eric
E
Noll
EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
Anne-Laure
AL
Charles
Department of Anesthesiology, University Hospital of Strasbourg, Strasbourg, France.|EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
Pierre
P
Diemunsch
EA 3072 Mitochondria and Oxidative Stress, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France.
Bernard
B
Geny
Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.|Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.
Yu-Yin
YY
Liu
Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.
Francesco
F
Marchegiani
Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.
Luigi
L
Schiraldi
Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.
Vincent
V
Agnus
Pathology Department, University Hospital of Strasbourg, Strasbourg, France.
Veronique
V
Lindner
IHU-Strasbourg, Institute for Minimally Invasive Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, France.
Lee
L
Swanström
Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.
Bernard
B
Dallemagne
IHU-Strasbourg, Institute for Minimally Invasive Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, France.|Institute for Research against Cancer of the Digestive System, IRCAD, Strasbourg, France.
Jacques
J
Marescaux
D000818:Animals; D001706:Biopsy; D002196:Capillaries; D004578:Electron Spin Resonance Spectroscopy; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D000069416:Intravital Microscopy; D018613:Microscopy, Confocal; D018384:Oxidative Stress; D055420:Perfusion Imaging; D012771:Shock, Hemorrhagic / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D013481:Superoxides / Q000378:metabolism; D054047:Surgical Stomas / Q000098:blood supply* / Q000473:pathology; D034421:Sus scrofa; D013552:Swine
D013481:Superoxides
Bowel perfusion; Confocal laser endomicroscopy; Electron paramagnetic resonance; Functional capillary density area; Hemorrhagic shock model; Mitochondria respiratory rate; Oxidative stress; Stoma perfusion