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Monitoring of Conjunctival Microcirculation Reflects Sublingual Microcirculation in Ovine Septic and Hemorrhagic Shock

Hessler, Michael*; Arnemann, Philip-Helge*; Zamit, Frédéric; Seidel, Laura*; Kampmeier, Tim-Gerald*; Kathöfer, Ulrich; Alnawaiseh, Maged; Tchaichian, Saman*; Rehberg, Sebastian§; Ertmer, Christian*

doi: 10.1097/SHK.0000000000001173
Basic Science Aspects

Introduction: The conjunctival region may serve as an alternative site for microcirculatory measurements. The present study was performed to investigate the correlation of sublingual and conjunctival microcirculation in ovine models of septic and hemorrhagic shock.

Methods: Septic shock was induced in 10 sheep by inoculation of feces into the peritoneal cavity until mean arterial pressure (MAP) was <60 mm Hg and arterial lactate level was ≥1.8 mmol· L−1. In another 10 sheep, hemorrhagic shock was induced by stepwise blood withdrawal of 3×10 mL·kg−1. Systemic hemodynamics and parameters of blood gas analysis were analyzed. Conjunctival and sublingual microcirculation were monitored and analyzed according to current recommendations. Parameters were measured at baseline and at shock time.

Results: Septic shock resulted in a significant drop in MAP and cardiac index (CI), and an increase in arterial lactate levels. While the total vessel density (TVD) in the sublingual microcirculation was relatively well maintained, the perfused vessel density (PVD) and the microvascular flow index (MFI) were significantly reduced in septic shock. Hemorrhagic shock reduced MAP and CI, and increased arterial lactate levels. TVD was relatively unchanged in hemorrhagic shock, while PVD and MFI were significantly decreased. The conjunctival microcirculation showed similar changes to the sublingual microcirculation in both models.

Conclusions: The findings of the current study support the proposed use of the conjunctiva as an alternative site for microcirculatory monitoring in hemorrhagic and septic shock. Further studies should focus on the impact of therapy and the loss of correlation between the different microcirculatory regions in advanced shock.

*Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany

IT-Centre for Research and Education, Medical Faculty of Muenster, University of Muenster, Muenster, Germany

Department of Ophthalmology, University Hospital of Muenster, Muenster, Germany

§Department of Anesthesiology, University of Greifswald, Greifswald, Germany

Address reprint requests to Michael Hessler, MD, Department of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany. E-mail:

Received 16 March, 2018

Revised 3 April, 2018

Accepted 27 April, 2018

MH and P-HA contributed equally to the manuscript.

MH received reimbursement of travel expenses from Astellas Pharma. T-GK received travel reimbursements and honoraria as a consultant from Fresenius Kabi Germany. SR received reimbursement of travel expenses from Orion Pharma and Astellas Pharma and is Medical Advisor for Fresenius Kabi Germany. The present work was supported by intramural funding of the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany.

The authors report no conflicts of interest.

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© 2019 by the Shock Society