Alterations of conjunctival glycocalyx and microcirculation in non-septic critically ill patients.

As of now the relationship between glycocalyx degradation and microcirculatory perfusion abnormalities in non-septic critical ill patients is unclear. In addition, conjunctival sidestream dark field-imaging for the purpose of glycocalyx thickness estimation has never been performed. We aimed to investigate whether changes in glycocalyx thickness in non-septic patients are associated with microcirculatory alterations in conjunctival and sublingual mucosa. In this single-centre prospective observational study, using techniques for direct in-vivo observation of the microcirculation, we performed a single measurement of microcirculatory perfusion parameters and visualized glycocalyx thickness in both ocular conjunctiva and sublingual mucosa in mixed cardio surgical (n = 18) and neurocritical patients (n = 27) and compared these data with age-matched healthy controls (n = 20). In addition we measured systemic syndecan-1 levels. In the sublingual and conjunctival region we observed a significant increase of the perfused boundary region (PBR) in both neuro-critical and cardiac surgical ICU patients, compared to controls. There was a significant increase of syndecan-1 in ICU patients comparing with controls and in cardiac patients comparing with neurological (120.0[71.0-189.6] vs. 18.0[7.2-40.7], p < 0.05). We detected a weak correlation between syndecan-1 and sublingual PBR but no correlations between global glycocalyx damage and conjuctival glycocalyx thickness. We found significantly lower perfused vessel density (PVD) of small vessels in sublingual mucosa in patients after cardiac surgery in comparison with healthy subjects. In neuro-critical, but not cardiac surgery patients conjunctival TVD and PVD of small vessels were found to be significantly lower in comparison with controls.

Hypertonic hydroxyethyl starch solution for hypovolaemia correction following heart surgery.

BACKGROUND: The aim of the study was to evaluate the effect of hypertonic NaCl hydroxyethyl starch solution on haemodynamics and cardiovascular parameters in the early postoperative period in patients for correction of hypovolaemia after heart surgery. METHODS: Eighty patients undergoing myocardial revascularisation at the Clinic of Cardiac Surgery of the Heart Centre (Kaunas University of Medicine) were randomly divided into two groups. The HyperHaes group (n = 40) received 250ml 7.2% NaCl/6% HES solution and the control Ringer's acetate group (n = 40) received placebo (500 ml Ringer's acetate solution) for volume correction after the surgery. RESULTS: After infusion of HyperHaes solution, cardiac index increased from 2.69 (0.7) to 3.52 (0.8) l/min/m2, systemic vascular resistance index, pulmonary vascular resistance index and the gradient between central and peripheral temperature decreased, and oxygen transport parameters improved. Ringer's group patients needed more intensive infusion therapy (4050.0 (1102.2) ml in the Ringer's group, 3513.7(762.5) ml in the HyperHaes group). During the first 24 hours postoperatively, diuresis was significantly higher in the HyperHaes group (3640.0 (1122.9) ml and 2736.0 (900.7) ml), total fluid balance was lower in HyperHaes group (1405.6 (1519.0) ml and 2718.3 (1508.0)ml, respectively). After the infusion of HyperHaes solution, no adverse events were noted. CONCLUSIONS: HyperHaes solution had a positive effect on haemodynamic parameters and microcirculation. Oxygen transport was more effective after HyperHaes solution infusion. Higher diuresis, lower need for the infusion therapy for the first 24 hours and lower total fluid balance were determined in the HyperHaes group. No adverse effects were observed after HyperHaes solution infusion.

[Use of hypertonic colloid solution in the treatment of heart failure in early postoperative period]. / Hipertoninio koloidinio tirpalo panaudojimas ankstyvuoju pooperaciniu laikotarpiu sirdies nepakankamumui gydyti.

OBJECTIVE: The aim of the study was to estimate the differences in hemodynamic, metabolic and cardiovascular parameters in early postoperative period in hypertonic colloid solution and usual infusion therapy groups. MATERIAL AND METHODS: The study was blind placebo controlled. Thirty patients were randomly divided into two groups. The control group received usual Ringer solution for hypovolemia correction and the study group received 250 ml of 7.2% NaCl/6% Hydroxyethylstarch (HyperHaes, Frezenius) solution. The measurements were made before, immediately after the infusion, 60 min and 180 min after infusion. The parameters of central hemodynamics, oxygen transport, the temperature gradient, electrolyte concentration and fluid balance were evaluated. RESULTS: After infusion of HyperHaes solution cardiac index increased from 2.8+/-0.2 to 3.8+/-0.3 L/min/m(2), pulmonary vascular resistance and systemic vascular resistance decreased. Serum Na(+)and Cl (-)increase in investigative group did not exceeded normal range and returned to initial level after an hour. The total fluid balance and fluid balance during surgery in investigative group was less than that in the control group. CONCLUSIONS: HyperHaes solution in early postoperative period after coronary artery bypass grafting surgery increased preload, had the tendency of decreasing afterload, increased cardiac index, decreased total fluid balance and did not cause hypernatremia and hyperchloremia.