Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Siebig S, Wiest R, Bruennler T, Wrede C. Crit Care Med.2009;37(12,suppl):A359.
Introduction: ICU patients with decompensated liver cirrhosis (LC) exhibit numerous hemodynamic and microvascular changes, i.e. low systemic blood pressure and peripheral vasodilatation. Those alterations predispose to multiple organ dysfunction syndrome and therefore increase morbidity and mortality in LC patients. Knowledge about alterations in tissue oxygenation in LC mostly comes from animal models since bedside monitoring is difficult to access. Near-infrared spectroscopy (NIRS) has been proposed as a new non-invasive tool to quantify microvascular dysfunction at the patient’s bedside.
Hypothesis: This study was conducted to determine alterations of microcirculatory function in decompensated LC patients using NIRS.
Methods: Thenar StO2 was measured continuously by NIRS (InSpectra®, Hutchinson) before (StO2 baseline), during, and after a 3-min arterial occlusion test in LC patients, treated on our medical ICU ward, and in healthy volunteers. Microvascular function was determined by assessing the slope of StO2 reperfusion [%/min]. In 9 LC patients, the occlusion test was repeated after 24 and 48 hours.
Results: So far, 9 LC patients (MELD score 30.6 ± 10.8, age 57 ± 8 years) and 9 controls (age 35 ± 6 years) were included in this analysis. There were no significant differences concerning baseline StO2 between the groups (83.5 % ± 3.8 vs. 84.1 % ± 1.5; p=0.88). However, StO2 reperfusion was significantly slower in patients with LC (slope 1.2 %/min ± 0.2 vs. 2.8 %/min ± 0.3; p=0.001). Furthermore, slopes tended to be higher in survivors compared to non-survivors.
Conclusions: Patients with decompensated LC demonstrated significant alterations in StO2 recovery after ischemic challenge, indicating impaired microcirculatory reactivity similar to that previously described in patients with sepsis. However, in contrast to septic patients, baseline tissue oxygenation was not different from healthy volunteers. StO2 slope tended to decrease over time in nonsurvivors compared to survivors. Thus, NIRS is capable of detecting microcirculatory alterations in patients with LC, and may be a valuable tool for assessing prognosis and therapy effects in these patients.