Correlation between early sublingual small vessel density and late blood lactate level in critically ill surgical patients

Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intens...

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Published in:The Journal of surgical research 2013-04, Vol.180 (2), p.317-321
Main Authors: Yeh, Yu-Chang, MD, Wang, Ming-Jiuh, PhD, Chao, Anne, MD, Ko, Wen-Je, PhD, Chan, Wing-Sum, MD, Fan, Shou-Zen, PhD, Tsai, Jui-Chang, PhD, Sun, Wei-Zen, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Critical Illness
Female
Humans
Intensive care
Lactate
Lactic Acid - blood
Male
Microcirculation
Middle Aged
Mouth Floor - blood supply
Prospective Studies
Surgery
Surgical Procedures, Operative
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Summary:Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. Methods This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. Results A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.476; P  = 0.008). Conclusions Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2012.05.006