Evaluation of sublingual microcirculation in a paediatric intensive care unit: prospective observational study about its feasibility and utility

BMC Pediatrics

Research Article

María José Santiago¹  Jorge López²  Javier Urbano²  Rafael González²  Sarah Nicole Fernández²  María José Solana²  Jesús López-Herce³ 

[1] Gregorio Marañón Health Research Institute, Calle Doctor Castelo 47, 28009, Madrid, Spain;Mother and Child Health and Development Network (Red SAMID), RETICS funded by the PN I+D+I 2008-2011, ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional 10.1186/s12887-017-0837-5 Development Fund, ref. RD12/0026., Madrid, Spain;Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Calle Doctor Castelo 47, 28009, Madrid, Spain;Gregorio Marañón Health Research Institute, Calle Doctor Castelo 47, 28009, Madrid, Spain;Mother and Child Health and Development Network (Red SAMID), RETICS funded by the PN I+D+I 2008-2011, ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional 10.1186/s12887-017-0837-5 Development Fund, ref. RD12/0026., Madrid, Spain;Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Calle Doctor Castelo 47, 28009, Madrid, Spain;Gregorio Marañón Health Research Institute, Calle Doctor Castelo 47, 28009, Madrid, Spain;Mother and Child Health and Development Network (Red SAMID), RETICS funded by the PN I+D+I 2008-2011, ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional 10.1186/s12887-017-0837-5 Development Fund, ref. RD12/0026., Madrid, Spain;School of Medicine, Complutense University of Madrid, Madrid, Spain;

关键词: Microcirculation;    Paediatric intensive care;    Shock;    Monitoring;    Critically ill child;   

DOI  :  10.1186/s12887-017-0837-5

 received in 2016-07-15, accepted in 2017-03-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundEvaluation of the microcirculation in critically ill patients is usually done by means of indirect parameters. The aim of our study was to evaluate the functional state of the microcirculation by direct visualization of sublingual microcirculation using Sidestream Dark Field Imaging, to determine the correlation between these findings and other parameters that are commonly used in the clinical practice and to assess the applicability of the systematic use of this technique in critically ill children.MethodsA prospective observational study was carried out in a Pediatric Intensive Care Unit (PICU) of a tertiary referral hospital. All patients admitted to the PICU during a three-month period were included in the study after obtaining the informed consent from the patient. Systematic evaluation of sublingual microcirculation was done in these patients (Total Vessel Density, Proportion of Perfused Vessels, Perfused Vessel Density, De Backer Score, Microvascular Flow Index, Heterogeneity Index) within the first day of admission (T1) and between the second and third day of admission (T2). Other clinical, hemodynamic, and biochemical parameters were measured and registered simultaneously. When the evaluation of the microcirculation was not feasible, the reason was registered. Descriptive analysis of our findings are expressed as means, medians, standard deviations and interquartile ranges. Mann–Whitney-Wilcoxon and Fisher tests were used to compare variables between patients with and without evaluation of the microcirculation. Pearson Correlation Coefficient (ρ) was used to evaluate the correlation between microcirculatory parameters and other clinical parameters.ResultsOne hundred fine patients were included during the study period. Evaluation of the microcirculation was feasible in 18 patients (17.1%). 95.2% of them were intubated. The main reason for not evaluating microcirculation was the presence of respiratory difficulty or the absence of collaboration (95.1% on T1 and 68.9% on T2). Evaluated patients had a higher prevalence of intubation and ECMO at admission (72.2% vs. 14.9% and 16.6% vs. 1.1%, respectively), and longer median duration of mechanical ventilation (0 vs. 6.5 days), vasoactive drugs (0 vs. 3.5 days) and length of stay (3 vs. 16.5 days) than non-evaluated patients. There was a moderate correlation between microcirculatory parameters and systolic arterial pressure, central venous pressure, serum lactate and other biochemical parameters used for motoring critically ill children.ConclusionsSystematic evaluation of microcirculation in critically ill children is not feasible in the unstable critically ill patient, but it is feasible in stable critically ill children. Microcirculatory parameters show a moderate correlation with other parameters that are usually monitored in critically ill children.

【 授权许可】

CC BY   
© The Author(s). 2017