Assessment of endothelial cell function and physiological microcirculatory reserve by video microscopy using a topical acetylcholine and nitroglycerin challenge

Intensive Care Medicine Experimental
Matthias Peter HiltyMarco Maggiorini

Abstract

Assessment of the microcirculation is a promising target for the hemodynamic management of critically ill patients. However, just as the sole reliance on macrocirculatory parameters, single static parameters of the microcirculation may not represent a sufficient guide. Our hypothesis was that by serial topical application of acetylcholine (ACH) and nitroglycerin (NG), the sublingual microcirculation can be challenged to determine its endothelial cell-dependent and smooth muscle-dependent physiological reserve capacity. In 41 healthy subjects, sublingual capillary microscopy was performed before and after topical application of ACH and NG. Total vessel density (TVD) was assessed in parallel using manual computer-assisted image analysis as well as a fully automated analysis pathway utilizing a newly developed computer algorithm. Flow velocity was assessed using space-time diagrams of the venules as well as the algorithm-based calculation of an average perfused speed indicator (APSI). No change in all measured parameters was detected after sublingual topical application of ACH. Sublingual topical application of NG however led to an increase in TVD, space-time diagram-derived venular flow velocity and APSI. No difference was detect...Continue Reading

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Citations

Jun 16, 2019·Critical Care : the Official Journal of the Critical Care Forum·Can Ince
Apr 30, 2020·Current Opinion in Critical Care·Matthias P Hilty, Can Ince
Apr 3, 2021·Intensive Care Medicine Experimental·Christian S GuayMohamed Badawy

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Clinical Trials Mentioned

NCT01953198

Software Mentioned

Epoc
CytoCam Tools
R library
R environment for statistical computing
ggplot2

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