Macro- and Microcirculation Crosstalk in Brain-damaged Patients Under Anesthesia or in Intensive Care

Summary

In patients with severe brain injury, maintenance and control of blood pressure is at the very first point in the management strategy, whether in anesthesia or in intensive care. In order to restore cerebral perfusion pressure (CPP) to appropriate levels (60-70 mmHg) while ensuring optimal perfusion of other vital organs, intravenous administration of vasodilator, inodilator or vasoconstrictor vasoactive agents is commonly used.

These vasoactive agents, widely used to correct hypotension or hypertension, have their own effects on the load conditions of the left ventricle and the tone of the arterial tree, but also have effects on the microcirculation.

The microcirculatory status of a tissue cannot be reliably predicted by considering only the macrocirculatory parameters usually measured.

Therefore, in situations where organ perfusion is inadequate or compromised, patient management that includes the integration of the impact of vasoactive agents on the microcirculation seems essential for comprehensive hemodynamic treatment.

The non-invasive study of microcirculatory perfusion and its interactions with the macrocirculatory network, using a minimally invasive method such as videomicroscopy, should allow a better use of the treatments used.

For cerebral patients, routine management already includes very complete monitoring of all cardiopulmonary and cerebral systemic parameters.

It is therefore imperative to study and propose new minimally invasive modalities for monitoring the microcirculation in order to define new therapeutic targets that take into account the microcirculatory compartment.

Conditions

• Brain Injury

Interventions

DIAGNOSTIC_TEST

Comparison of macro- and microcirculatory parameters

Microcirculation examination using sublingual videomicroscopy, tissue O2 saturation (StO2) by NIRS and transcutaneous CO2 pressure (tcpCO2) monitoring, in conjunction with macrocirculatory parameters measures including cardiac output, arterial pressure and pulsed O2 saturation, in order to establish the relationship between the macrocirculatory changes in blood pressure and cardiac output and the microcirculatory flow and capillary density during vasoactive agent use." . Participants receive interventions as part of routine medical care to restore Cerebral Perfusion pressure (CPP) to appropriate levels (60-70 mmHg)

Sponsors & Collaborators

• INSERM UMR-942, Paris, France

  collaborator OTHER

• LMS Polytechnique

  collaborator UNKNOWN

• M3DISIM Inria Université Paris-Saclay

  collaborator UNKNOWN

• Assistance Publique - Hôpitaux de Paris

  lead OTHER

Principal Investigators

• Joaquim MATEO, MD · AP-HP, Lariboisière Hospital, Department of Anesthesiology and Intensive Care

• Fabrice VALLEE, MD, PhD · AP-HP, Lariboisière Hospital, Department of Anesthesiology and Intensive Care

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-06-30

Primary Completion

2025-06-30

Completion

2025-07-31

Countries

• France

Study Locations