Monitoring tissue perfusion during extracorporeal circulation with laser speckle contrast imaging

Abstract

Objective: The laser speckle contrast imaging (LSCI) system is a method to evaluate microcirculation. The primary aim of our study is to evaluate the relationship between LSCI and perfusion markers in coronary artery bypass grafting (CABG). Our second aim is to investigate the relationship between LSCI and extubation time in the intensive care unit. Patients and Methods: Fifteen patients aged 43-80 years who will undergo on-pump CABG were included in the prospective study. Mean arterial pressure (mmHg), heart rate (min-1), PO2 (mmHg), PCO2 (mmHg) and lactate (mmol/L) levels were measured preinduction, post-induction, 10th minute of the extracorporeal circulation, post-crossclamp, and post-operatively. At the same time points, LSCI values from the skin were measured and recorded. The intubation times of the patients were also recorded. Results: There was no significant change in systemic tissue perfusion markers (P>0.05). LSCI perfusion values decreased significantly from induction and remained low until the end of surgery (P<0.05). The perfusion value (98±11 PU) of the patients who were intubated for less than 8 hours was better than the perfusion value (52±4.8 PU) of the patients who were intubated for more than 8 hours (P<0.05). Conclusion: In our study, a significant change occurred in skin tissue perfusion before systemic perfusion parameters in CABG, and low perfusion was associated with prolonged intubation time.

Keywords

• Skin perfusion
• Laser speckle contrast imaging
• Extracorporeal circulation
• Coronary artery bypass grafting
• Extubation time

References

1. Zarbock A, Hollmann MW. Perioperative organ failure: A preventable complication? Anesth Analg 2020;131:1663-5. doi:10.1213/ANE.000.000.0000005244
2. De Backer D, Orbegozo Cortes D, Donadello K, Vincent JL. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence 2014;5:73-9. doi:10.4161/viru.26482
3. Van Beest P, Wietasch G, Scheeren T, Spronk P, Kuiper M. Clinical review: use of venous oxygen saturations as a goal – a yet unfinished puzzle. Crit Care 2011;15:232. doi:10.1186/ cc10351
4. Vellinga NAR, Boerma EC, Koopmans M, Donati A, Dubin A, Shapiro NI. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Crit Care 2017;21:255. doi:10.1186/s13054.017.1842-7
5. Huette P, Beyls C, Mallat J, et al. Central venous-to-arterial CO(2) difference is a poor tool to predict adverse outcomes after cardiac surgery: a retrospective study. Can J Anaesth 2021;68:467-76. doi:10.1007/s12630.020.01881-4
6. Zhang X, Xuan W, Yin P, Wang L, Wu X, Wu Q. Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis. Crit Care 2015;19:22. doi:10.1186/ s13054.015.0739-6
7. Senarathna J, Rege A, Li N, Thakor NV. Laser Speckle Contrast Imaging: theory, instrumentation and applications. IEEE Rev Biomed Eng 2013;6:99-110. doi:10.1109/RBME.2013.224.3140
8. Zheng C, Lau LW, Cha J. Dual-display laparoscopic laser speckle contrast imaging for real-time surgical assistance. Biomed Opt Express 2018;9:5962-81. doi:10.1364/BOE.9.005962

9. Dubin A, Henriquez E, Hernandez G. Monitoring peripheral perfusion and microcirculation. Curr Opin Crit Care 2018;24:173-80. doi:10.1097/MCC.000.000.0000000495
10. Neubauer-Geryk J, Hoffmann M, Wielicka M, et al. Current methods for the assessment of skin microcirculation: Part 1. Postepy Dermatol Alergol 2019;36:247-54. doi:10.5114/ ada.2019.83656
11. Neubauer-Geryk J, Hoffmann M, Wielicka M, Piec K, Kozera G, Bieniaszewski L. Current methods for the assessment of skin microcirculation: Part 2. Postepy Dermatol Alergol 2019;36:377-81. doi:10.5114/ada.2019.83657
12. Holowatz LA, Thompson-Torgerson CS, Kenney WL. The human cutaneous circulation as a model of generalized microvascular function. J Appl Physiol (1985) 2008;105:370-2. doi:10.1152/japplphysiol.00858.2007
13. RG IJ, de Jongh RT, Beijk MA, et al. Individuals at increased coronary heart disease risk are characterized by an impaired microvascular function in skin. Eur J Clin Invest 2003;33:536- 42. doi:10.1046/j.1365-2362.2003.01179.x
14. Vincent JL, Rhodes A, Perel A, et al. Clinical review: Update on hemodynamic monitoring—a consensus of 16. Crit Care 2011;15:229. doi:10.1186/cc10291
15. Dyson A, Cone S, Singer M, Ackland GL. Microvascular and macrovascular flow are uncoupled in early polymicrobial sepsis. Br J Anaesth 2012;108:973-8. doi:10.1093/bja/aes093
16. Wu Y, Ren J, Zhou B, et al. Laser speckle contrast imaging for measurement of hepatic microcirculation during the sepsis: a novel tool for early detection of microcirculation dysfunction. Microvasc Res 2015;97:137-46. doi:10.1016/j.mvr.2014.10.006
17. De Backer D, Donadello K, Sakr Y, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 2013;41:791-9. doi:10.1097/CCM.0b013e3182742e8b
18. Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of regional perfusion and organ function: Less and non-invasive techniques. Front Med (Lausanne) 2019;6:50. doi:10.3389/fmed.2019.00050
19. Briers D, Duncan DD, Hirst E, et al. Laser speckle contrast imaging: theoretical and practical limitations. J Biomed Opt 2013;18:066018. doi:10.1117/1.JBO.18.6.066018
20. Ambrus R, Strandby RB, Svendsen LB, Achiam MP, Steffensen JF, Sondergaard Svendsen MB. Laser speckle contrast imaging for monitoring changes in microvascular blood flow. Eur Surg Res 2016;56:87-96. doi:10.1159/000442790
21. Eriksson S, Nilsson J, Lindell G, Sturesson C. Laser speckle contrast imaging for intraoperative assessment of liver microcirculation: a clinical pilot study. Med Devices (Auckl) 2014;7:257-61. doi:10.2147/MDER.S63393
22. Barcelos A, Lamas C, Tibirica E. Evaluation of microvascular endothelial function in patients with infective endocarditis using laser speckle contrast imaging and skin video-capillaroscopy: research proposal of a case control prospective study. BMC Res Notes 2017;10:342. doi:10.1186/s13104.017.2660-3
23. Feuer DS, Handberg EM, Mehrad B, et al. Microvascular Dysfunction as a Systemic Disease: A Review of the Evidence. Am J Med 2022;135:1059-68. doi:10.1016/j.amjmed.2022.04.006
24. Gaillard-Bigot F, Roustit M, Blaise S, et al. Abnormal amplitude and kinetics of digital postocclusive reactive hyperemia in systemic sclerosis. Microvasc Res 2014;94:90-5. doi:10.1016/j. mvr.2014.05.007
25. Kiss F, Molnar L, Hajdu E, et al. Skin microcirculatory changes reflect early the circulatory deterioration in a fulminant sepsis model in the pig. Acta Cir Bras 2015;30:470-7. doi:10.1590/ S0102.865.0201500.700.00004
26. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008;134:172-8. doi:10.1378/chest.07-2331
27. Vincent JL, Pelosi P, Pearse R, et al. Perioperative cardiovascular monitoring of high risk patients: a consensus of 12. Crit Care 2015; 19:224. doi: 10.1186/s13054.015.0932-7
28. Margouta A, Anyfanti P, Lazaridis A, et al. Blunted microvascular reactivity in psoriasis patients in the absence of cardiovascular disease, as assessed by laser speckle contrast imaging. Life (Basel) 2022;12:1796. doi:10.3390/life12111796