Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study
Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study
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DOI：
10.1371/journal.pone.0213085
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发表时间：
2019-03-05
期刊：
影响因子：
3.7
通讯作者：
Donati, Abele
中科院分区：
文献类型：
--
作者：
Domizi, Roberta;Damiani, Elisa;Donati, Abele
简介之前的研究将微血管灌注和组织氧合受损描述为重大创伤中多器官衰竭的可靠预测因素。然而，这种关系尚未得到完全研究。本分析的目的是进一步评估创伤后器官功能障碍与微循环之间的关联。材料和方法这是对参加危重患者微循环每日监测研究（NCT 02649088）的 28 名创伤患者进行的回顾性亚组分析。根据第 4 天的序贯器官衰竭评估 (SOFA) 评分，将患者分为两组。入院时和每 24 小时，使用侧流暗视野成像 (SDF) 评估舌下微循环，并使用近红外光谱 (NIRS) 和血管闭塞试验 (VOT) 评估外周组织灌注。同时收集血流动力学、临床/实验室参数和主要器官支持。结果第4天的中位SOFA评分为6.5。因此，患者被分为两组：D4-SOFA。 6.5 和 D4-SOFA >6.5。与 D4-SOFA 相比，D4-SOFA>6.5 的患者在重症监护室的住院时间显着更长。 6.5（p = 0.013）。 D4-SOFA 评分高的患者入院后第 1 天 (p = 0.002) 和第 2 天 (p = 0.006) 的小血管总密度显着较低； D4-SOFA 评分高的患者在第 1 天 (p = 0.007) 和第 2 天 (p = 0.033) 的灌注血管密度较低。在第 1 天，使用 VOT 进行 NIRS 监测显示，高 D4-SOFA 患者的组织氧饱和度下降速度明显加快（p = 0.018），上升速度较慢（p = 0.04）。讨论在我们的重大创伤队列中，对于那些出现更严重器官功能障碍的患者，舌下微循环和外周微血管反应性在创伤后早期明显受损。我们的数据支持这样的假设：大循环的恢复可以与外周和组织灌注的恢复分离，并且微血管的改变可能与器官衰竭相关。
IntroductionPrevious studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma.Materials and methodsThis is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected.ResultsMedian SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA. 6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA. 6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA.DiscussionIn our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.