Microcirculation in shocked patients

Evaluating microcirculation with regards to how sick a patient is and whether or not they recover from illness.

Grant ID: PROJ-2009-012-LUKIN-MICRO

Project Summary

Microcirculation refers to very small blood vessels that control oxygen and nutrient delivery and removal of waste products from our tissues and organs. Previous research has shown that a decrease in either the number of vessels, or blood flow through these vessels, can be seen in patients who are very sick as a result of infections, blood loss or heart failure. Changes in microcirculation are associated with how sick a patient is and whether or not they recover from illness. However, only small numbers have been included in other studies.

The principle hypothesis of this research is that abnormalities of the microcirculation -- identified with sidestream dark field (SDF) imaging not necessarily discernable with global measure of perfusion -- will correlate with ongoing organ dysfunction in shocked critically unwell patients.

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Outcomes

This study was completed in December 2017, involving 84 patients. Data analysis is still underway; implications for practice will be determined once this is completed.

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Leveraged Funds

- $20,000 - RBWH

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Dissemination

Holley, A.D., Dulhunty, J., Udy, A., Midwinter, M., Lukin, B., Stuart, J., Boots, R., Lassig-Smith, M., Holley, R.B., Paratz, J. and Lipman, J., 2021. Early sequential microcirculation assessment in shocked patients as a predictor of outcome: a prospective observational cohort study. Shock, 55(5), pp.581-586.

Vellinga, N.A., Boerma, E.C., Koopmans, M., Donati, A., Dubin, A., Shapiro, N.I., Pearse, R.M., van der Voort, P.H., Dondorp, A.M., Bafi, T. and Fries, M., 2017. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Critical Care, 21(1), pp.1-9.

Vellinga, N.A., Boerma, E.C., Koopmans, M., Donati, A., Dubin, A., Shapiro, N.I., Pearse, R.M., Machado, F.R., Fries, M., Akarsu-Ayazoglu, T. and Pranskunas, A., 2015. International study on microcirculatory shock occurrence in acutely ill patients. Critical care medicine, 43(1), pp.48-56.

Holley, A., Lukin, W., Paratz, J., Hawkins, T., Boots, R. and Lipman, J., 2012. Part one: Goal‐directed resuscitation–Which goals? Haemodynamic targets. Emergency Medicine Australasia, 24(1), pp.14-22.

Holley, A., Lukin, W., Paratz, J., Hawkins, T., Boots, R. and Lipman, J., 2012. Part two: Goal‐directed resuscitation–Which goals? Perfusion targets. Emergency Medicine Australasia, 24(2), pp.127-135.

Holley, A., Udy, A., Lipman, J. and Paratz, J.D., 2009. The microcirculation, regional blood flow and tissue oxygenation: will new technologies drive new resuscitation goals?. Anaesthesia and intensive care, 37(5), pp.700-702.

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