Microvascular Perfusion as a Target for Fluid Resuscitation in Experimental Circulatory Shock

Michel van Genderen, Eva Klijn, Alexandre Pinto Lima, Jeroen de Jonge, SS Visser, Jacqueline Voorbeijtel, Hanneke Bakker, Jasper van Bommel

Research output: Contribution to journalArticleAcademicpeer-review

42 Citations (Scopus)

Abstract

Objectives: To study regional perfusion during experimental endotoxemic and obstructive shock and compare the effect of initial cardiac output-targeted fluid resuscitation with optimal cardiac output-targeted resuscitation on different peripheral tissues. Design: Controlled experimental study. Setting: University-affiliated research laboratory. Subjects: Fourteen fasted anesthetized mechanically ventilated domestic pigs. Interventions: Domestic pigs were randomly assigned to the endotoxemic (n = 7) or obstructive shock (n = 7) model. Central and regional perfusion parameters were obtained at baseline, during greater than or equal to 50% reduction of cardiac output (T1), after initial resuscitation to baseline (T2), and after optimization of cardiac output (T3). Measurements and Main Results: Regional perfusion was assessed in the sublingual, intestinal, and muscle vascular beds at the different time points and included visualization of the microcirculation, measurement of tissue oxygenation, and indirect assessments of peripheral skin perfusion. Hypodynamic shock (T1) simultaneously decreased all regional perfusion variables in both models. In the obstructive model, these variables returned to baseline levels at T2 and remained in this range after T3, Conclusions: This study demonstrates that the relationship between the systemic and regional perfusion is dependent on the underlying cause of circulatory shock. Further research will have to demonstrate whether different microvascular perfusion variables can be used as additional resuscitation endpoints.
Original languageUndefined/Unknown
Pages (from-to)E96-E105
JournalCritical Care Medicine
Volume42
Issue number2
DOIs
Publication statusPublished - 2014

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