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The sublingual microcirculation throughout neonatal and pediatric extracorporeal membrane oxygenation treatment: Is it altered by systemic extracorporeal support?
- Source :
- Frontiers in pediatrics, 7(JULY):272. Frontiers Media S.A., Frontiers in Pediatrics, Frontiers in Pediatrics, 7:272. Frontiers Media S.A., Frontiers in Pediatrics, Vol 7 (2019)
- Publication Year :
- 2019
-
Abstract
- Background: Extracorporeal membrane oxygenation (ECMO) treatment alleviates systemic cardiorespiratory failure. However, it is unclear whether ECMO also improves microcirculatory function, as the microcirculation can be disturbed despite normal systemic hemodynamics. We therefore aimed to study the sublingual microcirculation (SMC) throughout neonatal and pediatric ECMO treatment. We hypothesized that the SMC improves after starting ECMO, that the SMC differs between venovenous (VV) and venoarterial (VA) ECMO, and that insufficient recovery of microcirculatory disturbances during ECMO predicts mortality.Methods: This single-center prospective longitudinal observational study included 34 consecutive children (April 2016—September 2018). The SMC was assessed daily with a handheld vital microscope (integrated with incident dark field illumination) before, during, and after ECMO. Validated parameters of vessel density, perfusion, and flow quality were assessed for all vessels (diameter 2.6) increased with higher MAP (OR: 1.050, 95%CI: 1.008–1.094). Microcirculatory parameters did not significantly differ between VV and VA ECMO or between survivors and non-survivors. None of the microcirculatory parameters could predict mortality on ECMO or overall mortality.Conclusion: In this heterogeneous study population, we were not able to demonstrate an effect of ECMO on the sublingual microcirculation. Microcirculatory parameters did not change throughout ECMO treatment and did not differ between VV and VA ECMO or between survivors and non-survivors. Future research should focus on determining which neonatal and pediatric ECMO patients would benefit from microcirculatory monitoring and how.
- Subjects :
- medicine.medical_specialty
Sublingual microcirculation
medicine.medical_treatment
microcirculation
030204 cardiovascular system & hematology
Pediatrics
hemodynamic monitoring
Extracorporeal
Microcirculation
03 medical and health sciences
0302 clinical medicine
Vessel density
030225 pediatrics
Internal medicine
Extracorporeal membrane oxygenation
medicine
Original Research
business.industry
lcsh:RJ1-570
lcsh:Pediatrics
extracorporeal membrane oxygenation
neonates
critical care
surgical procedures, operative
Systemic hemodynamics
Cardiorespiratory failure
Pediatrics, Perinatology and Child Health
Cardiology
business
Perfusion
Subjects
Details
- Language :
- English
- ISSN :
- 22962360
- Database :
- OpenAIRE
- Journal :
- Frontiers in pediatrics, 7(JULY):272. Frontiers Media S.A., Frontiers in Pediatrics, Frontiers in Pediatrics, 7:272. Frontiers Media S.A., Frontiers in Pediatrics, Vol 7 (2019)
- Accession number :
- edsair.doi.dedup.....092b5003c3bb0fe1c52d852ef18bc1ed