Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis*

Abstract

OBJECTIVE: To evaluate the relation between sublingual and intestinal microcirculatory alterations in patients with abdominal sepsis. DESIGN: Prospective observational study. SETTING: A 23-bed mixed intensive care unit of a tertiary teaching hospital. PATIENTS: Twenty-three patients with abdominal sepsis and a newly constructed intestinal stoma were included in the study group. Nineteen outpatient healthy individuals with an intestinal stoma and ten nonsepsis patients with a <24-hr-old intestinal stoma were included as controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Orthogonal polarization spectral imaging of the sublingual and intestinal microcirculation was performed on days 1 and 3. In addition, variables of systemic hemodynamics, such as cardiac index, heart rate, blood pressure, central venous pressure, and dosages of vasopressor and inotropic agents, were obtained. On day 1 there was no correlation of the microvascular flow index between the sublingual and intestinal microcirculatory beds (Spearman's rho [rs] = .12; 95% confidence interval, -.51 to .31; p = .59). Furthermore, there was no significant correlation between microcirculatory alterations and variables of systemic circulation (rs <or= .25). On day 3, however, a correlation between sublingual and intestinal microcirculatory flow appeared to be restored (rs = .74; 95% confidence interval, .28-.92; p = .006), mainly due to a normalization of flow in both regions. CONCLUSIONS: On day 1 of abdominal sepsis there is a complete dispersion of flow, not only between hemodynamic compartments of a different order but also between the sublingual and intestinal microcirculation. Over time, both sublingual and intestinal microvascular flow indexes trended to normal values.