Dataset Information

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery-a prospective cohort study.

ABSTRACT:

Background

Persistent microcirculatory dysfunction associated with increased morbidity and mortality. Interventions in the early resuscitation can be tailored to the changes of microcirculation and patient's need. However, there is usually an uncoupling of macrocirculatory and microcirculatory hemodynamics during resuscitation. Current research on the patterns of microcirculatory changes and recovery after cardiopulmonary bypass (CPB)-assisted cardiac surgery is limited. This study aimed to analyze changes in the microcirculatory parameters after CPB and their correlation with macrocirculation and to explore the characteristics of microcirculatory changes following CPB-assisted cardiac surgery.

Methods

Between December 2018 and January 2019, 24 adult patients with indwelling pulmonary artery catheters after elective cardiac surgery using CPB were enrolled in this study. Both microcirculatory and macrocirculatory parameters were collected at 0, 6, 16, and 24 hours after admission to the intensive care unit (ICU). Video images of sublingual microcirculation were analyzed to obtain the microcirculatory parameters, including total vascular density (TVD), perfused small vessel density (PSVD), the proportion of perfused small vessels (PPV), microvascular flow index (MFI), and flow heterogeneity index (HI). The characteristics of microcirculatory parameter change following cardiac surgery and the correlation between microcirculatory parameters and macroscopic hemodynamic indicators, oxygen metabolic indicators, and carbon dioxide partial pressure difference (PCO₂gap) were analyzed.

Results

There were significant differences in the changes of TVD (P=0.012) and PSVD (P=0.005) during the first 24 hours postoperatively in patients who underwent CPB-assisted cardiac surgery. The microcirculatory density parameters (TVD: r=-0.5059, P=0.0456; PVD: r=-0.5499, P=0.0273) were correlated with oxygen delivery index (DO₂I) at 24 hours after surgery. The microcirculatory flow parameters (PPV: r=0.4370, P=0.0327; MFI: r=0.6496, P=0.0006; and HI: r=-0.5350, P=0.0071) had a strong correlation with PCO₂gap at 0 hour after surgery.

Conclusions

TVD and PSVD might be two most sensitive indicators affected by CPB-assisted cardiac surgery. There was no consistency between microcirculation and macrocirculation until 24 hours following cardiac surgery, meaning the improvement of systemic hemodynamic indicators does not guarantee correspondently improvement in microcirculation. Early controlled oxygen supply after CPB-assisted cardiac surgery may be conducive to the resuscitation of patients to a certain extent.

SUBMITTER: Li X

PROVIDER: S-EPMC9641360 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery-a prospective cohort study.

Li Xiaofeng X Tan Tong T Wu Hongxiang H Zhang Chongjian C Luo Dandong D Zhu Weizhong W Li Boyu B Zhuang Jian J

Journal of thoracic disease 20221001 10

<h4>Background</h4>Persistent microcirculatory dysfunction associated with increased morbidity and mortality. Interventions in the early resuscitation can be tailored to the changes of microcirculation and patient's need. However, there is usually an uncoupling of macrocirculatory and microcirculatory hemodynamics during resuscitation. Current research on the patterns of microcirculatory changes and recovery after cardiopulmonary bypass (CPB)-assisted cardiac surgery is limited. This study aimed ...[more]

PMID: 36389306

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Project description:BackgroundMicrocirculatory perfusion disturbances are associated with increased morbidity and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Technological advancements made it possible to monitor sublingual microcirculatory perfusion over time. The goal of this review is to provide an overview of the course of alterations in sublingual microcirculatory perfusion following CPB. The secondary goal is to identify which parameter of sublingual microcirculatory perfusion is most profoundly affected by CPB.MethodsPubMed and Embase databases were systematically searched according to PRISMA guidelines and as registered in PROSPERO. Studies that reported sublingual microcirculatory perfusion measurements before and after onset of CPB in adult patients undergoing cardiac surgery were included. The primary outcome was sublingual microcirculatory perfusion, represented by functional capillary density (FCD), perfused vessel density (PVD), total vessel density (TVD), proportion of perfused vessels (PPV), and microvascular flow index (MFI).ResultsThe search identified 277 studies, of which 19 fulfilled all eligibility criteria. Initiation of CPB had a profound effect on FCD, PVD, or PPV. Seventeen studies (89%) reported one or more of these parameters, and in 11 of those studies (65%), there was a significant decrease in these parameters during cardiac surgery; the other 6 studies (35%) reported no effect. In 29% of the studies, FCD, PVD, or PPV normalized by the end of cardiac surgery, and in 24% percent of the studies, this effect lasted at least 24?h. There was no clear effect of CPB on TVD and a mixed effect on MFI.ConclusionCPB during cardiac surgery impaired sublingual microcirculatory perfusion as reflected by reduced FCD, PVD, and PPV. Four studies reported this effect at least 24?h after surgery. Further research is warranted to conclude on the duration of CPB-induced microcirculatory perfusion disturbances and the relationship with clinical outcome.Trial registrationPROSPERO, CRD42019127798.

Project description:BackgroundEndothelial hyperpermeability following cardiopulmonary bypass (CPB) contributes to microcirculatory perfusion disturbances and postoperative complications after cardiac surgery. We investigated the postoperative course of renal and pulmonary endothelial barrier function and the association with microcirculatory perfusion and angiopoietin-2 levels in patients after CPB.MethodsClinical data, sublingual microcirculatory data, and plasma samples were collected from patients undergoing coronary artery bypass graft surgery with CPB (n = 17) before and at several time points up to 72 h after CPB. Renal and pulmonary microvascular endothelial cells were incubated with patient plasma, and in vitro endothelial barrier function was assessed using electric cell-substrate impedance sensing. Plasma levels of angiopoietin-1,-2, and soluble Tie2 were measured, and the association with in vitro endothelial barrier function and in vivo microcirculatory perfusion was determined.ResultsA plasma-induced reduction of renal and pulmonary endothelial barrier function was observed in all samples taken within the first three postoperative days (P < 0.001 for all time points vs. pre-CPB). Angiopoietin-2 and soluble Tie2 levels increased within 72 h after CPB (5.7 ± 4.4 vs. 1.7 ± 0.4 ng/ml, P < 0.0001; 16.3 ± 4.7 vs. 11.9 ± 1.9 ng/ml, P = 0.018, vs. pre-CPB), whereas angiopoietin-1 remained stable. Interestingly, reduced in vitro renal and pulmonary endothelial barrier moderately correlated with reduced in vivo microcirculatory perfusion after CPB (r = 0.47, P = 0.005; r = 0.79, P < 0.001). In addition, increased angiopoietin-2 levels moderately correlated with reduced in vitro renal and pulmonary endothelial barrier (r = - 0.46, P < 0.001; r = - 0.40, P = 0.005) and reduced in vivo microcirculatory perfusion (r = - 0.43, P = 0.01; r = - 0.41, P = 0.03).ConclusionsCPB is associated with an impairment of in vitro endothelial barrier function that continues in the first postoperative days and correlates with reduced postoperative microcirculatory perfusion and increased circulating angiopoietin-2 levels. These results suggest that angiopoietin-2 is a biomarker for postoperative endothelial hyperpermeability, which may contribute to delayed recovery of microcirculatory perfusion after CPB.Trial registrationNTR4212 .

Project description:ObjectiveTo identify risk factors for postoperative delirium in adult patients undergoing cardiopulmonary bypass.MethodsThe medical records of 214 patients who underwent cardiopulmonary bypass at the First Affiliated Hospital of Hunan Normal University from January 2022 to January 2024 were retrospectively analyzed. Based on the occurrence of postoperative delirium, patients were divided into a delirium group (49 cases) and a non-delirium group (165 cases). Outcome measures, including clinical baseline data, preoperative left ventricular ejection fraction (LVEF), preoperative Acute Physiology and Chronic Health Evaluation II (APACHE II) score, anesthesia duration, surgery duration, aortic cross-clamp duration, intraoperative mean arterial pressure (MAP), intraoperative blood loss, length of intensive care unit (ICU) stay, postoperative mechanical ventilation duration, as well as postoperative MAP, were compared between the two groups. Logistic regression analysis was performed to identify the potential factors associated with post-operative delirium in patients.ResultsOf the included 214 patients, 49 patients experienced delirium, resulting in an incidence of 22.90%. The delirium group had significantly lower LVEF and significantly higher APACHE II scores compared to the non-delirium group (all P<0.001). No significant difference was observed between the two groups in terms of anesthesia duration, surgery duration, aortic cross-clamp duration, intraoperative MAP, and intraoperative blood loss (all P>0.05). The delirium group experienced significantly longer length of ICU stay and postoperative mechanical ventilation duration as compared to the non-delirium group (all P<0.001), but no significant difference was observed in terms of postoperative MAP between the two groups (P>0.05). Logistic regression analysis identified preoperative New York Heart Association classification (NYHA) (OR: 6.755, 95% CI: 2.529-18.039, P<0.001), preoperative LVEF (OR: 6.886, 95% CI: 2.383-19.899, P<0.001), preoperative APACHE II score (OR: 7.788, 95% CI: 2.740-22.135, P<0.001), length of ICU stay (OR: 9.463, 95% CI: 3.563-25.135, P<0.001), and postoperative mechanical ventilation duration (OR: 9.744, 95% CI: 3.419-27.768, P<0.001) as independent factors influencing the occurrence of delirium in adult patients undergoing cardiopulmonary bypass.ConclusionPostoperative delirium is a prevalent complication among patients undergoing cardiac surgery. Independent risk factors for postoperative delirium in adult patients undergoing cardiopulmonary bypass during cardiac surgery include preoperative NYHA class III or IV, lower LVEF, higher APACHE II score, an extended length of stay in the ICU, and prolonged postoperative mechanical ventilation duration.

Dataset Information

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery-a prospective cohort study.

Background

Methods

Results

Conclusions

Publications

Characteristics of sublingual microcirculatory changes during the early postoperative period following cardiopulmonary bypass-assisted cardiac surgery-a prospective cohort study.

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