Severe Impairment of Microcirculatory Perfused Vessel Density Is Associated With Postoperative Lactate and Acute Organ Injury After Cardiac Surgery

JC Greenwood, DH Jang, SD Hallisey, JT Gutsche, J Horak, MA Acker, CA Bermudez, VL Zhou, S Chatterjee, FS Shofer, TJ Kilbaugh, JGT Augoustides, NJ Meyer, Hanneke Bakker, BS Abella

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22 Citations (Scopus)

Abstract

Objective: Resuscitation after cardiac surgery needs to address multiple pathophysiological processes that are associated with significant morbidity and mortality. Functional microcirculatory derangements despite normal systemic hemodynamics have been previously described but must be tied to clinical outcomes. The authors hypothesized that microcirculatory dysfunction after cardiac surgery would include impaired capillary blood flow and impaired diffusive capacity and that subjects with the lowest quartile of perfused vessel density would have an increased postoperative lactate level and acute organ injury scores. Design: Prospective, observational study. Setting: A single, tertiary university cardiovascular surgical intensive care unit. Participants: 25 adults undergoing elective cardiac surgery requiring cardiopulmonary bypass. Intervention: Sublingual microcirculation was imaged using incident dark field microscopy before and 2 to 4 hours after surgery in the intensive care unit. Measurements and Main Results: Compared with baseline measurements, postoperative vessel-by-vessel microvascular flow index (2.9 [2.8-2.9] v 2.5 [2.4-2.7], p < 0.0001) and perfused vessel density were significantly impaired (20.7 [19.3-22.9] v 16.3 [12.8-17.9], p < 0.0001). The lowest quartile of perfused vessel density (<12.8 mm/mm2) was associated with a significantly increased postoperative lactate level (6.0 ± 2.9 v 1.8 ± 1.2, p < 0.05), peak lactate level (7.6 ± 2.8 v 2.8 ± 1.5, p = 0.03), and sequential organ failure assessment (SOFA) score at 24 and 48 hours. Conclusion: In patients undergoing cardiac surgery, there was a significant decrease in postoperative microcirculatory convective blood flow and diffusive capacity during early postoperative resuscitation. Severely impaired perfused vessel density, represented by the lowest quartile of distribution, is significantly related to hyperlactatemia and early organ injury.

Original languageEnglish
Pages (from-to)106-115
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume35
Issue number1
DOIs
Publication statusPublished - 2021

Bibliographical note

Funding Information:
We are extremely grateful to the subjects who took part in the presented study, support from the Abramson Emergency Medicine and Critical Care Research Fund, the ESICM Next Fellowship, which enabled the microcirculation research mentorship experience, and the University of Pennsylvania’s Center for Resuscitation Science for its continued research support and guidance.

Publisher Copyright:
© 2020 Elsevier Inc.

Research programs

  • EMC OR-01

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