Surgery Clinical Trial
Official title:
Kinetics of the Sublingual Microcirculation During the Treatment of a Postoperative Shock
Fluid therapy is one of the cornerstones of the treatment of organ failure. The investigators
assume that fluid bolus will increase the delivery of oxygen to the cells and resolve the
shock.
The purpose of this study is to asses kinetics of the sublingual microcirculation in one
place during a fluid bolus. It is expected that fluid therapy after normalization of the red
blood cell flow velocity in the microcirculation will result in a decrease in capillary
density through the formation of edema in the tissues. This can be considered to be the
tipping of potentially beneficial to deleterious effects of fluid therapy.
After cardiac surgery patient will be transferred to the ICU for further stabilisation.
Within specific indications the patient will receive a fluid bolus, these indications are
hypotension, hyperlactataemia, tachycardia or decreased urine production. The fluid bolus
will be 250 ml crystalloids in 15 minutes. The investigators will observe the sublingual
microcirculation during this fluid bolus. To asses the red blood cell velocity and capillary
vessel density on one spot during this fluid bolus.
Fluid therapy is one of the cornerstones of the treatment of organ failure. The investigators
assume that a fluid bolus will increase the delivery of oxygen to the cells and resolve the
shock. The evaluation of this treatment is done by clinical signs of organ perfusion en
(little used) invasive hemodynamic monitoring. Previous research suggests that in-vivo
microscopy of the microcirculation can be of importance to determine the type of shock and
the reaction on treatment on tissue level.
Evaluation of the microcirculation was done by measuring red blood cell velocity on three
different sites in the sublingual region. This was necessary in order to take heterogeneity
into account, it was very hard to fix the camera on one spot during the observation period.
The purpose of this study is to asses kinetics of the sublingual microcirculation in one
place during a fluid bolus. The great advantage is that the recordings before and after fluid
therapy can be compared with each other as paired data, wherein the subject is its own
control. By choosing a time interval that is long enough for the observation of the changes,
but short enough for manual fixing of the camera, it seems possible to serve both purposes
(15-30 minutes). This seems crucial now because both red blood cell flow as capillary density
will be measured. It is expected that fluid therapy after normalization of the red blood cell
flow velocity in the microcirculation will result in a decrease in capillary density through
the formation of edema in the tissues. This can be considered to be the tipping of
potentially beneficial to deleterious effects of fluid therapy.
After cardiac surgery patient will be transferred to the ICU for further stabilisation.
Within specific indications the patient will receive a fluid bolus, these indications are
hypotension, hyperlactataemia, tachycardia or decreased urine production. The fluid bolus
will be 250 ml crystalloids in 15 minutes. The investigators will observe the sublingual
microcirculation during this fluid bolus. To asses the red blood cell velocity and capillary
vessel density on one spot during this fluid bolus.
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