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Assessment of Microcirculation Alteration With Both Sublingual Microcirculation and Near-infrared Spectroscopy on ARDS

NCT05180409 · Status: UNKNOWN · Type: OBSERVATIONAL · Enrollment: 60

Last updated 2022-01-06

No results posted yet for this study

Summary

Microcirculatory alterations are frequently observed in critically ill and severe sepsis patients characterized by a decrease in capillary density and an increase in heterogeneity of perfusion. This derangements result in microcirculatory shunting and oxygen extraction deficit, and plays a major role in the pathophysiology of sepsis and multi-organ failure. Loss of hemodynamic coherence between the macro- and microcirculation results in persistent and incomplete reversal of microcirculatory and regional hypoxia that is the major factor contributing to the development of organ failure.

Current techniques permitting monitoring the microcirculation can be classified in two main groups: (1) Methods for evaluation of local tissue oxygenation as a surrogate of microcirculatory blood flow. (2)Methods allowing direct visualization of the microvascular network and microcirculatory blood flow.

Near-infrared spectroscopy (NIRS) is a non-invasive technique for evaluating tissue oxygenation in vessels with a diameter \< 1 mm (arterioles, capillaries, and venules). Recent systemic review studies have showed that patients with severe sepsis or septic shock have lower levels of StO2, moreover, survivors present higher levels of StO2 compared with non-survivors. Reactive hyperemia during vascular occlusion test (VOT) can be considered an integral test of microcirculatory reactivity, evaluating the tissue's ability to adjust oxygen extraction capabilities to oxygen delivery after a hypoxic stimulus induced by a transient interruption in blood flow. Continuous StO2 measurement and VOT derived StO2 deoxygenation slope and StO2 recovery slope have been found to be predictors of mortality and organ dysfunction.

Sublingual microcirculation allows direct visualization of the sublingual microcirculation and for quantitative determination of variables of flow, capillary density, and flow distribution. Microvascular alterations including decreased functional capillary density, increased perfusion heterogeneity, and increased proportion of stopped and intermittently perfused capillaries, are more severe in non-survivors than in survivors. In addition, persistence of these alterations was strongly and independently correlated with multi-organ failure and mortality.

ARDS is the most severe form of acute lung injury in ICU with mortality about 45% without achievement in ten years. However, only few studies were focused on the microcirculatory alterations in ARDS patients.

Conditions

  • Acute Respiratory Distress Syndrome

Sponsors & Collaborators

  • Chang Gung Memorial Hospital

    lead OTHER

Principal Investigators

  • Chung Chi Huang, MD · Chang Gung Memorial Hospital

Eligibility

Min Age
20 Years
Max Age
90 Years
Sex
ALL
Healthy Volunteers
No

Timeline & Regulatory

Start
2020-12-01
Primary Completion
2022-11-30
Completion
2022-11-30

Countries

  • Taiwan

Study Locations

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Read the full study record

This page highlights key information. For complete eligibility criteria, study locations, investigator contacts, and the full protocol, visit the original record on ClinicalTrials.gov.

View NCT05180409 on ClinicalTrials.gov