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Jochen-Frederick Hernekamp, Florian Neubrech, Tomke Cordts, Volker J Schmidt, Ulrich Kneser, Thomas Kremer
PURPOSE: The clinical course after major burns is characterized by microcirculatory changes and consecutive capillary leakage. However, current clinical monitoring does not properly assess microcirculation, whereas macrohemodynamic changes are continuously evaluated. Here, we assess if macrohemodynamic and microhemodynamic parameters after burn trauma are correlated in a rat model. METHODS: Burn plasma harvested from donor rats 4 hours after thermal injury (30% total body surface area, 100 °C water, 12 seconds) was administered intravenously to healthy animals during 2 hours of intravital microscopy (burn group [BG])...
October 17, 2016: Annals of Plastic Surgery
Patrick Lauscher, Harry Kertscho, Malte Krömker, Barbara Haberichter, Kai Zacharowski, Peter Rosenberger, Jens Meier
BACKGROUND: Clonidine effectively decreases perioperative mortality by reducing sympathetic tone. However, application of clonidine might also restrict anaemia tolerance due to impairment of compensatory mechanisms. Therefore, the influence of clonidine induced, short-term sympathicolysis on anaemia tolerance was assessed in anaesthetized pigs. We measured the effect of clonidine on anaemia tolerance and of the potential for macrohemodynamic alterations to constrain the acute anaemia compensatory mechanisms...
October 12, 2016: BMC Anesthesiology
Bulent Ergin, Philippe Guerci, Lara Zafrani, Frank Nocken, Asli Kandil, Ebru Gurel-Gurevin, Cihan Demirci-Tansel, Can Ince
BACKGROUND: Modulation of inflammation and oxidative stress appears to limit sepsis-induced damage in experimental models. The kidney is one of the most sensitive organs to injury during septic shock. In this study, we evaluated the effect of N-acetylcysteine (NAC) administration in conjunction with fluid resuscitation on renal oxygenation and function. We hypothesized that reducing inflammation would improve the microcirculatory oxygenation in the kidney and limit the onset of acute kidney injury (AKI)...
December 2016: Intensive Care Medicine Experimental
Atila Kara, Sakir Akin, Can Ince
PURPOSE OF REVIEW: Critical illness includes a wide range of conditions from sepsis to high-risk surgery. All these diseases are characterized by reduced tissue oxygenation. Macrohemodynamic parameters may be corrected by fluids and/or vasoactive compounds; however, the microcirculation and its tissues may be damaged and remain hypoperfused. An evaluation of microcirculation may enable more physiologically based approaches for understanding the pathogenesis, diagnosis, and treatment of critically ill patients...
October 2016: Current Opinion in Critical Care
Atila Kara, Sakir Akin, Can Ince
PURPOSE OF REVIEW: Cardiac surgery is associated with a wide range of microvascular derangements and with reduced tissue oxygenation. Although the macrohemodynamical targets during surgery may be achieved, the microcirculation may be damaged and remain dysfunctional. Direct observations of the microcirculation may enable more physiologically based approaches for diagnosis and treatment during cardiac surgery. RECENT FINDINGS: Microcirculation is the final destination of blood flow to the tissues for oxygen transport...
February 2016: Current Opinion in Anaesthesiology
Dániel Érces, Miklós Nógrády, Gabriella Varga, Szilárd Szűcs, András Tamás Mészáros, Tamás Fischer-Szatmári, Chun Cao, Noriko Okada, Hidechika Okada, Mihály Boros, József Kaszaki
BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) can evolve in a variety of low-flow states. Although the mechanisms leading to NOMI-related intestinal necrosis are largely unknown, circumstantial evidence suggests that excessive vasoconstriction and complement activation both play important roles in this process. Because targeting of the circulatory malfunction of the splanchnic area could be of therapeutic relevance, we set out to investigate the long-term effects of treatment with a complement C5a antagonist in a rat model of partial aortic occlusion (PAO)-induced transient mesenteric hypoperfusion...
March 2016: Surgery
Namkje A R Vellinga, Gerke Veenstra, Claudia Scorcella, Matty Koopmans, Eric N van Roon, Can Ince, E Christiaan Boerma
INTRODUCTION: Microcirculatory alterations in sepsis are associated with increased morbidity and mortality. These alterations occur despite macrohemodynamic resuscitation. Alternative pro-microcirculatory strategies, including vasodilatory drugs, have been suggested to improve capillary blood flow. Ketanserin, a serotonin receptor antagonist, is an attractive candidate because of its vasodilatory, antithrombotic, and anti-inflammatory effects. METHODS: This is an open-label pilot study on the effect of ketanserin administration on microcirculatory alterations in septic shock, defined as microvascular flow index (MFI)≤2...
December 2015: Journal of Critical Care
Alejandra López, Juan Carlos Grignola, Martín Angulo, Ignacio Alvez, Nicolás Nin, Gonzalo Lacuesta, Manuel Baz, Pablo Cardinal, Ivana Prestes, Juan P Bouchacourt, Juan Riva, Can Ince, Francisco Javier Hurtado
BACKGROUND: Microcirculation and macrohemodynamics are severely compromised during septic shock. However, the relationship between these two compartments needs to be further investigated. We hypothesized that early resuscitation restores left ventricular (LV) performance and microcirculatory function but fails to prevent metabolic disorders. We studied the effects of an early resuscitation protocol (ERP) on LV pressure/volume loops-derived parameters, sublingual microcirculation, and metabolic alterations during endotoxic shock...
December 2015: Intensive Care Medicine Experimental
G Gruartmoner, J Mesquida, Can Ince
PURPOSE OF REVIEW: In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring...
August 2015: Current Opinion in Critical Care
Arend-Jan Meinders, Laurens Nieuwenhuis, Can Ince, Willem-Jan Bos, Paul W G Elbers
Hemodynamic changes during haemodialysis are common. Often these changes are associated with symptoms that are thought to be the result of reduced microcirculatory blood flow and oxygen delivery. The microcirculatory effect of hemodialysis is scarcely researched, though of possible influence on patient outcome. New techniques have become available to visualise and analyse microvascular blood flow. We performed an observational study using Sidestream Dark Field imaging, a microscopic technique using polarised light to visualise erythrocytes passing through sublingual capillaries, to analyse the effect of haemodyalisis on central microvascular blood flow...
2015: Blood Purification
John R Prowle, Rinaldo Bellomo
Traditionally, renal ischemia has been regarded as central to the pathogenesis of sepsis-associated acute kidney injury (SA-AKI). Accordingly, hemodynamic management of SA-AKI has emphasized restoration of renal perfusion, whereas, experimentally, ischemia reperfusion models have been emphasized. However, in human beings, SA-AKI usually is accompanied by hyperdynamic circulation. Moreover, clinical and experimental evidence now suggests the importance of inflammatory mechanisms in the development of AKI and microcirculatory dysfunction more than systemic alteration in renal perfusion...
January 2015: Seminars in Nephrology
Christian Kleber, Christopher A Becker, Tom Malysch, Jens M Reinhold, Serafeim Tsitsilonis, Georg N Duda, Katharina Schmidt-Bleek, Klaus D Schaser
Hemorrhagic shock (hS) interacts with the posttraumatic immune response and fracture healing in multiple trauma. Due to the lack of a long-term survival multiple trauma animal models, no standardized analysis of fracture healing referring the impact of multiple trauma on fracture healing was performed. We propose a new long-term survival (21 days) murine multiple trauma model combining hS (microsurgical cannulation of carotid artery, withdrawl of blood and continuously blood pressure measurement), femoral (osteotomy/external fixation) and tibial fracture (3-point bending technique/antegrade nail)...
July 2015: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Jakob Wollborn, Christian Wunder, Jana Stix, Winfried Neuhaus, Rapahel R Bruno, Wolfgang Baar, Sven Flemming, Norbert Roewer, Nicolas Schlegel, Martin A Schick
OBJECTIVE: To investigate the impact of the phophodiesterase-4 inhibition (PD-4-I) with rolipram on hepatic integrity in lipopolysaccharide (LPS) induced hyperinflammation. MATERIALS AND METHODS: Liver microcirculation in rats was obtained using intravital microscopy. Macrohemodynamic parameters, blood assays, and organs were harvested to determine organ function and injury. Hyperinflammation was induced by LPS and PD-4-I rolipram was administered intravenously one hour after LPS application...
January 2015: Journal of Pharmacology & Pharmacotherapeutics
Bernd Saugel, Constantin J Trepte, Kai Heckel, Julia Y Wagner, Daniel A Reuter
Septic shock is a life-threatening condition in both critically ill medical patients and surgical patients during the perioperative phase. In septic shock, specific alterations in global cardiovascular dynamics (i.e., the macrocirculation) and in the microcirculatory blood flow (i.e., the microcirculation) have been described. However, the presence and degree of microcirculatory failure are in part independent from systemic macrohemodynamic variables. Macrocirculatory and microcirculatory failure can independently induce organ dysfunction...
June 2015: Shock
Tomás Regueira, Max Andresen, Marcelo Mercado, Felipe Lillo, Dagoberto Soto
BACKGROUND: Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality. AIM: To evaluate the impact of macrohemodynamic and microcirculatory changes on renal function and histology during an experimental model of intra-abdominal sepsis. MATERIAL AND METHODS: In 18 anaesthetized pigs, catheters were installed to measure hemodynamic parameters in the carotid, right renal and pulmonary arteries...
May 2014: Revista Médica de Chile
Satoshi Homma, Taizo Kimura, Satoshi Sakai, Ken-ichi Yanagi, Yumi Miyauchi, Kazutaka Aonuma, Takashi Miyauchi
AIMS: Calcitonin gene-related peptide (CGRP) is a potent vasodilator neuropeptide. We investigated the ameliorating effect of CGRP in myocardial ischemia induced by endothelin-1 (ET-1), with special emphasis on myocardial microvascular hemodynamics and levels of energy-related metabolites. MAIN METHODS: The Langendorff preparations of rat isolated heart were perfused at a constant flow rate. Microvascular blood flow was also visualized in the anterior epicardium of the left ventricle by means of an intravital fluorescence microscope system...
November 24, 2014: Life Sciences
Sven Flemming, Nicolas Schlegel, Christian Wunder, Michael Meir, Wolfgang Baar, Jakob Wollborn, Norbert Roewer, Christoph-Thomas Germer, Martin Alexander Schick
BACKGROUND: Breakdown of microvascular endothelial barrier functions contributes to disturbed microcirculation, organ failure, and death in sepsis. Increased endothelial cAMP levels by systemic application of phosphodiesterase 4 inhibitors (PD-4-I) have previously been demonstrated to protect microvascular barrier properties in a model of systemic inflammation (systemic inflammatory response syndrome) suggesting a novel therapeutic option to overcome this problem. However, in a clinically relevant model of polymicrobial sepsis long-term effects, immunomodulatory effects and effectivity of PD-4-I to stabilize microvascular barrier functions and microcirculation remained unexplored...
June 2014: Shock
Hernando Gomez, Can Ince, Daniel De Backer, Peter Pickkers, Didier Payen, John Hotchkiss, John A Kellum
Given that the leading clinical conditions associated with acute kidney injury (AKI), namely, sepsis, major surgery, heart failure, and hypovolemia, are all associated with shock, it is tempting to attribute all AKI to ischemia on the basis of macrohemodynamic changes. However, an increasing body of evidence has suggested that in many patients, AKI can occur in the absence of overt signs of global renal hypoperfusion. Indeed, sepsis-induced AKI can occur in the setting of normal or even increased renal blood flow...
January 2014: Shock
Johannes Kalder, Dieudonne Ajah, Paula Keschenau, Lieven N Kennes, Rene Tolba, Maria Kokozidou, Michael J Jacobs, Thomas A Koeppel
OBJECTIVE: Extracorporeal circulation (ECC) is regularly applied to maintain organ perfusion during major aortic and cardiovascular surgery. During thoracoabdominal aortic repair, ECC-driven selective visceral arterial perfusion (SVP) results in changed microcirculatory perfusion (shift from the muscularis toward the mucosal small intestinal layer) in conjunction with macrohemodynamic hypoperfusion. The underlying mechanism, however, is unclear. Therefore, the aim of this study was to assess in a porcine model whether ECC itself or the hypoperfusion induced by SVP is responsible for the mucosal/muscular shift in the small intestinal wall...
February 2015: Journal of Vascular Surgery
Jordi Masip, Jaume Mesquida, Cecilia Luengo, Gisela Gili, Gemma Gomà, Ricard Ferrer, Jean Louis Teboul, Didier Payen, Antonio Artigas
BACKGROUND: Sepsis is a leading cause of death despite appropriate management. There is increasing evidence that microcirculatory alterations might persist independently from macrohemodynamic improvement and are related to clinical evolution. Future efforts need to be directed towards microperfusion monitoring and treatment. This study explored the utility of thenar muscle oxygen saturation (StO2) and its changes during a transient vascular occlusion test (VOT) to measure the microcirculatory response to drotrecogin alfa (activated) (DrotAA) in septic patients...
2013: Annals of Intensive Care
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