Background: Microcirculatory alterations have been observed at the early phase of sepsis, although macrocirculation seems preserved. The aim of this study was to analyze the effect of crystalloid fluid therapy on mesenteric microcirculation, assessed by using the confocal laser endomicroscope Cellvizio®, in an endotoxic porcine model. Methods: It is a prospective endotoxic shock (lipopolysaccharide infusion) experimental trial. Piglets were divided into 3 groups: 6 in the sham group (no LPS injection, no fluid), 9 in the control group (LPS infusion, no fluid), and 6 in the crystalloids group (LPS infusion and fluid resuscitation with crystalloids). Fluid resuscitation consisted in a fluid bolus of 20 mL/kg 0.9% saline over 30 min followed by a 10 mL/kg/h fluid rate over 4 h. Mesenteric microcirculation was assessed using a confocal laser endomicroscope (Cellvizio®). Blood flow within capillaries was visually assessed according to the point of care microcirculation (POEM) score. Results: At baseline, the 3 groups were similar regarding hemodynamic, biological, and microcirculatory parameters. At T360, the POEM score significantly decreased in the control and crystalloids groups, whereas it remained unchanged in the sham group (respectively, 1.62 ± 1.06, 1.2 ± 0.45, and 5.0 ± 0, p = 0.011). There was no significant difference in cardiac output at T360 between the sham and crystalloids groups (3.1 ± 0.8 vs. 2.3 ± 0.6, p = 0.132) or between the control and crystalloids groups (2.0 ± 0.6 vs. 2.3 ± 0.6, p = 0.90). Conclusion: There was no significant improvement of microcirculatory alterations after crystalloids resuscitation despite improvement in macrocirculatory parameters in early experimental sepsis.

1.
De Backer
D
,
Ricottilli
F
,
Ospina-Tascón
GA
.
Septic shock: a microcirculation disease
.
Curr Opin Anaesthesiol
.
2021 Apr 1
;
34
(
2
):
85
91
.
2.
De Backer
D
,
Creteur
J
,
Preiser
JC
,
Dubois
MJ
,
Vincent
JL
.
Microvascular blood flow is altered in patients with sepsis
.
Am J Respir Crit Care Med
.
2002 Jul 1
;
166
(
1
):
98
104
.
3.
Ma
S
,
Evans
RG
,
Iguchi
N
,
Tare
M
,
Parkington
HC
,
Bellomo
R
,
.
Sepsis-induced acute kidney injury: a disease of the microcirculation
.
Microcirculation
.
2019 Feb
;
26
(
2
):
e12483
.
4.
Johansson
P
,
Stensballe
J
,
Ostrowski
S
.
Shock induced endotheliopathy (SHINE) in acute critical illness – a unifying pathophysiologic mechanism
.
Crit Care
.
2017 Feb;21(2):25
[cited 2018 Jan 15]
. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299749/.
5.
Sakr
Y
,
Dubois
MJ
,
De Backer
D
,
Creteur
J
,
Vincent
JL
.
Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock
.
Crit Care Med
.
2004 Sept
;
32
(
9
):
1825
31
.
6.
Dyson
A
,
Cone
S
,
Singer
M
,
Ackland
GL
.
Microvascular and macrovascular flow are uncoupled in early polymicrobial sepsis
.
Br J Anaesth
.
2012 Jun
;
108
(
6
):
973
8
.
7.
Lipińska-Gediga
M
.
Sepsis and septic shock – is a microcirculation a main player
.
Anaesthesiol Intensive Ther
.
2016
;
48
(
4
):
5
.
8.
Edul
VS
,
Enrico
C
,
Laviolle
B
,
Vazquez
AR
,
Ince
C
,
Dubin
A
.
Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock
.
Crit Care Med
.
2012 May
;
40
(
5
):
1443
8
.
9.
Dubin
A
,
Kanoore Edul
VS
,
Caminos Eguillor
JF
,
Ferrara
G
.
Monitoring microcirculation: utility and barriers – a point-of-view review
.
Vasc Health Risk Manag
.
2020 Dec
;
16
:
577
89
.
10.
De Backer
D
,
Ospina-Tascon
G
,
Salgado
D
,
Favory
R
,
Creteur
J
,
Vincent
JL
.
Monitoring the microcirculation in the critically ill patient: current methods and future approaches
.
Intensive Care Med
.
2010 Nov
;
36
(
11
):
1813
25
.
11.
Boerma
EC
,
van der Voort
PH
,
Spronk
PE
,
Ince
C
.
Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis
.
Crit Care Med
.
2007 Apr
;
35
(
4
):
1055
60
.
12.
Assimakopoulos
SF
,
Triantos
C
,
Thomopoulos
K
,
Fligou
F
,
Maroulis
I
,
Marangos
M
,
.
Gut-origin sepsis in the critically ill patient: pathophysiology and treatment
.
Infection
.
2018 Dec
;
46
(
6
):
751
60
.
13.
Wang
KK
,
Carr-Locke
DL
,
Singh
SK
,
Neumann
H
,
Bertani
H
,
Galmiche
J-P
,
.
Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence
.
United European Gastroenterol J
.
2015 Jun
;
3
(
3
):
230
54
.
14.
Laemmel
E
,
Genet
M
,
Le Goualher
G
,
Perchant
A
,
Le Gargasson
JF
,
Vicaut
E
.
Fibered confocal fluorescence microscopy (Cell-viZio) facilitates extended imaging in the field of microcirculation. A comparison with intravital microscopy
.
J Vasc Res
.
2004 Oct
;
41
(
5
):
400
11
.
15.
Schmidt
C
,
Lautenschläger
C
,
Petzold
B
,
Sakr
Y
,
Marx
G
,
Stallmach
A
.
Confocal laser endomicroscopy reliably detects sepsis-related and treatment-associated changes in intestinal mucosal microcirculation
.
Br J Anaesth
.
2013 Dec
;
111
(
6
):
996
1003
.
16.
Chia
PY
,
Teo
A
,
Yeo
TW
.
Overview of the assessment of endothelial function in humans
.
Front Med
.
2020 Oct 7
;
7
:
542567
.
17.
Andersson
A
,
Rundgren
M
,
Kalman
S
,
Rooyackers
O
,
Brattstrom
O
,
Oldner
A
,
.
Gut microcirculatory and mitochondrial effects of hyperdynamic endotoxaemic shock and norepinephrine treatment
.
Br J Anaesth
.
2012 Feb
;
108
(
2
):
254
61
.
18.
Bennett
VA
,
Vidouris
A
,
Cecconi
M
.
Effects of fluids on the macro- and microcirculations
.
Crit Care
.
2018 Mar 20
;
22
(
1
):
74
.
19.
Pottecher
J
,
Deruddre
S
,
Teboul
J-L
,
Georger
J-F
,
Laplace
C
,
Benhamou
D
,
.
Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients
.
Intensive Care Med
.
2010 Nov
;
36
(
11
):
1867
74
.
20.
Aboab
J
,
Sebille
V
,
Jourdain
M
,
Mangalaboyi
J
,
Gharbi
M
,
Mansart
A
,
.
Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock
.
Intensive Care Med
.
2011 Aug
;
37
(
8
):
1344
51
.
21.
Rhodes
A
,
Evans
LE
,
Alhazzani
W
,
Levy
MM
,
Antonelli
M
,
Ferrer
R
,
.
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock
.
Crit Care Med
.
2017 Mar
;
45
(
3
):
486
552
.
22.
Vercauteren
T
,
Doussoux
F
,
Cazaux
M
,
Schmid
G
,
Linard
N
,
Durin
M-A
,
.
Endoscopic microscopy VIII
. In:
Tearney
GJ
,
Wang
TD
, editors.
Multicolor probe-based confocal laser endomicroscopy: a new world for in vivo and real-time cellular imaging
.
San Francisco, California, USA
;
2013
. p.
857504
[cited 2020 Mar 23]. Available from: http://proceedings.spiedigitallibrary.org/proceeding.aspx?doi=10.1117/12.2002490.
23.
Ince
C
,
Boerma
EC
,
Cecconi
M
,
Backer
DD
,
Shapiro
NI
,
Duranteau
J
,
.
Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine
.
Intensive Care Med
.
2018 Mar
;
44
(
3
):
281
99
.
24.
Naumann
DN
,
Mellis
C
,
Husheer
SLG
,
Hopkins
P
,
Bishop
J
,
Midwinter
MJ
,
.
Real-time point of care microcirculatory assessment of shock: design, rationale and application of the point of care microcirculation (POEM) tool
.
Crit Care
.
2016 Sept 30
;
20
(
1
):
310
.
25.
Foundation for statistical computing. R: the R project for statistical computing [Internet]. [cited 2018 Mar 31]. Available from: https://www.r-project.org/.
26.
Bland
JM
,
Altman
DG
.
Multiple significance tests: the Bonferroni method
.
BMJ
.
1995 Jan 21
;
310
(
6973
):
170
.
27.
Kottner
J
,
Audigé
L
,
Brorson
S
,
Donner
A
,
Gajewski
BJ
,
Hróbjartsson
A
,
.
Guidelines for reporting reliability and agreement studies (GRRAS) were proposed
.
J Clin Epidemiol
.
2011 Jan
;
64
(
1
):
96
106
.
28.
Fleiss
JL
,
Cohen
J
.
The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability
.
Educ Psychol Meas
.
1973 Oct 1
;
33
(
3
):
613
9
.
29.
Cohen
J
.
Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit
.
Psychol Bull
.
1968 Oct
;
70
(
4
):
213
20
.
30.
DiCiccio
TJ
,
Efron
B
.
Bootstrap confidence intervals
.
Statist Sci
.
1996;11(3):189–228
[cited 2019 Jan 30]
. Available from: https://projecteuclid.org/euclid.ss/1032280214.
31.
Nakajima
Y
,
Baudry
N
,
Duranteau
J
,
Vicaut
E
.
Microcirculation in intestinal villi: a comparison between hemorrhagic and endotoxin shock
.
Am J Respir Crit Care Med
.
2001 Oct 15
;
164
(
8
):
1526
30
.
32.
Trzeciak
S
,
McCoy
JV
,
Dellinger
RP
,
Arnold
RC
,
Rizzuto
M
,
Abate
NL
,
.
Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 hours in patients with sepsis
.
Intensive Care Med
.
2008 Dec
;
34
(
12
):
2210
7
.
33.
López
A
,
Grignola
JC
,
Angulo
M
,
Alvez
I
,
Nin
N
,
Lacuesta
G
,
.
Effects of early hemodynamic resuscitation on left ventricular performance and microcirculatory function during endotoxic shock
.
Intensive Care Med Exp
.
2015 Dec
;
3
(
1
):
14
.
34.
Ergin
B
,
Zafrani
L
,
Kandil
A
,
Baasner
S
,
Lupp
C
,
Demirci
C
,
.
Fully balanced fluids do not improve microvascular oxygenation, acidosis and renal function in a rat model of endotoxemia
.
Shock
.
2016
;
46
(
1
):
83
91
.
35.
Damiani
E
,
Ince
C
,
Orlando
F
,
Pierpaoli
E
,
Cirioni
O
,
Giacometti
A
,
.
Effects of the infusion of 4% or 20% human serum albumin on the skeletal muscle microcirculation in endotoxemic rats
.
PLoS One
.
2016
;
11
(
3
):
e0151005
.
36.
Pranskunas
A
,
Koopmans
M
,
Koetsier
PM
,
Pilvinis
V
,
Boerma
EC
.
Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy
.
Intensive Care Med
.
2013 Apr
;
39
(
4
):
612
9
.
37.
Ospina-Tascon
G
,
Neves
AP
,
Occhipinti
G
,
Donadello
K
,
Büchele
G
,
Simion
D
,
.
Effects of fluids on microvascular perfusion in patients with severe sepsis
.
Intensive Care Med
.
2010 Jun
;
36
(
6
):
949
55
.
38.
Ince
C
.
The microcirculation is the motor of sepsis
.
Crit Care
.
2005
;
9
(
Suppl 4
):
S13
9
.
39.
De Backer
D
,
Donadello
K
,
Taccone
FS
,
Ospina-Tascon
G
,
Salgado
D
,
Vincent
JL
.
Microcirculatory alterations: potential mechanisms and implications for therapy
.
Ann Intensive Care
.
2011 Jul 19
;
1
:
27
.
40.
Hua
T
,
Wu
X
,
Wang
W
,
Li
H
,
Bradley
J
,
Peberdy
MA
,
.
Micro- and macrocirculatory changes during sepsis and septic shock in a rat model
.
Shock
.
2018 May
;
49
(
5
):
591
5
.
41.
Vincent
JL
, editor.
Annual update in intensive care and emergency medicine 2014 [Internet]
. 1st ed.
Annual update in intensive care and emergency medicine 2014
.
Springer International Publishing
;
2014
[cited 2018 May 28]. Available from: http://gen.lib.rus.ec/book/index.php?md5=86d98fce62faa4b074c5d296785b1fd1.
42.
Orbegozo
D
,
Su
F
,
Santacruz
C
,
He
X
,
Hosokawa
K
,
Creteur
J
,
.
Effects of different crystalloid solutions on hemodynamics, peripheral perfusion, and the microcirculation in experimental abdominal sepsis
.
Anesthesiology
.
2016 Oct
;
125
(
4
):
744
54
.
43.
Moore
CL
,
Rose
GA
,
Tayal
VS
,
Sullivan
DM
,
Arrowood
JA
,
Kline
JA
.
Determination of left ventricular function by emergency physician echocardiography of hypotensive patients
.
Acad Emerg Med
.
2002 Mar
;
9
(
3
):
186
93
.
44.
Ince
C
.
The rationale for microcirculatory guided fluid therapy
.
Curr Opin Crit Care
.
2014 Jun
;
20
(
3
):
301
8
.
45.
Potter
EK
,
Hodgson
L
,
Creagh-Brown
B
,
Forni
LG
.
Manipulating the microcirculation in sepsis – the impact of vasoactive medications on microcirculatory blood flow: a systematic review
.
Shock
.
2019 Jul
;
52
(
1
):
5
12
.
46.
Yang
K-Y
,
Liu
K-T
,
Chen
Y-C
,
Chen
C-S
,
Lee
Y-C
,
Perng
R-P
,
.
Plasma soluble vascular endothelial growth factor receptor-1 levels predict outcomes of pneumonia-related septic shock patients: a prospective observational study
.
Crit Care
.
2011
;
15
(
1
):
R11
.
47.
Hoffmann
JN
,
Vollmar
B
,
Laschke
MW
,
Inthorn
D
,
Schildberg
FW
,
Menger
MD
.
Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia
.
Anesthesiology
.
2002 Aug
;
97
(
2
):
460
70
.
48.
Dubin
A
,
Pozo
MO
,
Casabella
CA
,
Murias
G
,
Pálizas
F
,
Moseinco
MC
,
.
Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients
.
J Crit Care
.
2010 Dec
;
25
(
4
):
659.e1
8
.
49.
Obonyo
NG
,
Fanning
JP
,
Ng
ASY
,
Pimenta
LP
,
Shekar
K
,
Platts
DG
,
.
Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review
.
Intensive Care Med Exp
.
2016 Dec
;
4
(
1
):
38
.
You do not currently have access to this content.