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.
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.
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.
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: Michael.email@example.com
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.
Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com).