Electronic poster

0839 - CLINICAL ASSESSMENT OF THE ENDOTHELIAL GLYCOCALYX TO MONITOR VASCULAR DYSFUNCTION IN SEPTIC SHOCK PATIENTS
H. Vink1, S. Hubble2, K.A. Wijnands3, C. Thorn4, D. Mawson4, S. Roos1, M. Poeze3, A. Shore4
1University Medical Center, Physiology, Maastricht, Netherlands, 2Universities of Exeter & Plymouth, ICU, Exeter, United Kingdom, 3University Medical Center, Surgery, Maastricht, Netherlands, 4Universities of Exeter & Plymouth, Peninsula College of Medicine and Dentistry, Exeter, United Kingdom
Lisbon 2012
Abstract
INTRODUCTION. Endothelial dysfunction contributes to multiple organ failure and vascular pathophysiology of septic shock. The endothelial glycocalyx is essential for protection of the vascular wall against pathogenic challenges and it is hypothesized that loss of glycocalyx marks the pathogenesis of endothelial dysfunction in septic shock. In physiological conditions, an intact glycocalyx shields the endothelial surface from circulating blood cells. Validation studies have demonstrated that experimentally induced loss of glycocalyx results in increased radial movement of erythocytes (RBCs) towards the luminal endothelial membrane, as reflected by corresponding increases in the dimension of the blood perfused boundary region (PBR). Monitoring the glycocalyx may therefore be a promising tool to determine the vascular health in sepsis.
OBJECTIVE. To determine whether clinical measurement of glycocalyx loss can be used to monitor the progression of vascular vulnerability in septic shock patients.
METHODS. A sidestream dark field (SDF) clinical videomicroscope connected to a GlycoCheck ICU glycocalyx measurement system was used to measure the PBR of sublingual vessels. On-line quality controlled videorecordings of sublingual microvessels were analyzed automatically to determine PBR in at least 3000 vascular segments per patient per measurement to monitor loss of glycocalyx in resuscitated septic shock patients (SEPSIS, n=28), ICU-control patients (ICU; n=5). Patients were compared to normal healthy persons (HEALTHY; n=31). Septic shock was defined according to the Consensus. 11 patients with sepsis did not survive. Patients were included from ICU´s in Exeter (17 SEPSIS) and Maastricht (11 SEPSIS, 5 ICU, 31 HEALTHY).
RESULTS. Dimensions of the RBC perfused boundary regions (PBR) averaged from 1.86 (SD 0.18) microns in HEALTHY, 2.22 (SD 0.17) microns in ICU, 2.55 (SD 0.39) microns in surviving SEPSIS to 2.89 (SD 0.47) microns in nonsurviving SEPSIS patients. Compared to HEALTHY individuals, these findings indicate that glycocalyx dimension is reduced by 0.33 microns in ICU (P=0.0003 ), 0.67 microns in surviving SEPSIS (P=9.64015E-11 ) and by 1.03 microns in nonsurviving SEPSIS (P=7.2799E-13 ), with a significant difference between the surviving and non-surviving SEPSIS patients (P=0.045).
CONCLUSIONS. Glycocalyx loss is significantly greater in nonsurviving SEPSIS patients. Measurement of changes in glycocalyx dimension might allow clinical monitoring of pathogenic vascular processes in SEPSIS and provide a tool to measure vascular consequences of therapeutic interventions.
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07-Apr-14 14:25 :
Ursula Schumacher

Excellent! Long awaited method!
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