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Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial

BACKGROUND: Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. However, the therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcircula...

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Autores principales: Kiudulaite, Inga, Belousoviene, Egle, Vitkauskiene, Astra, Pranskunas, Andrius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025901/
https://www.ncbi.nlm.nih.gov/pubmed/33829305
http://dx.doi.org/10.1186/s13613-021-00848-y
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author Kiudulaite, Inga
Belousoviene, Egle
Vitkauskiene, Astra
Pranskunas, Andrius
author_facet Kiudulaite, Inga
Belousoviene, Egle
Vitkauskiene, Astra
Pranskunas, Andrius
author_sort Kiudulaite, Inga
collection PubMed
description BACKGROUND: Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. However, the therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcirculation in patients with sepsis. METHODS: This prospective single-arm trial was performed in a mixed ICU at a tertiary teaching hospital. We included patients with sepsis or septic shock within 24 h of ICU admission. The RIC procedure comprised 3 cycles of brachial cuff inflation to 200 mmHg for 5 min followed by deflation to 0 mmHg for another 5 min. The procedure took 30 min. RIC was performed at the time of study inclusion and repeated after 12 and 24 h. Sublingual microcirculatory measurements were obtained before and after each RIC procedure using a Cytocam(®)-incident dark-field (IDF) device (Braedius Medical, Huizen, The Netherlands). The microcirculatory data were compared with a historical control. Data are reported as the medians along with the 25th and 75th percentiles. RESULTS: Twenty-six septic patients with a median age of 65 (57–81) years were enrolled in this study. The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at admission were 20 (13–23) and 10 (9–12), respectively. All patients were receiving vasopressors. After the 1st RIC procedure, the microvascular flow index (MFI) and the proportion of perfused vessels (PPV) among small vessels were significantly higher than before the procedure, with pre- and post-treatment values of 2.17 (1.81–2.69) and 2.59 (2.21–2.83), respectively, for MFI (p = 0.003) and 87.9 (82.4–93.8) and 92.5 (87.9–96.1) %, respectively, for PPV (p = 0.026). This result was confirmed by comparison with a historical control group. We found no change in microcirculatory flow or density parameters during repeated RIC after 12 h and 24 h. CONCLUSION: In patients with sepsis, the first remote ischemic conditioning procedure improved microcirculatory flow, whereas later procedures did not affect sublingual microcirculation. Trial registration NCT04644926, http://www.clinicaltrials.gov. Date of registration: 25 November 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04644926.
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spelling pubmed-80259012021-04-08 Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial Kiudulaite, Inga Belousoviene, Egle Vitkauskiene, Astra Pranskunas, Andrius Ann Intensive Care Research BACKGROUND: Remote ischemic conditioning (RIC) is a promising technique that may protect organs and tissues from the effects of additional ischemic episodes. However, the therapeutic efficacy of RIC in humans with sepsis remains unknown. We hypothesized that RIC might improve sublingual microcirculation in patients with sepsis. METHODS: This prospective single-arm trial was performed in a mixed ICU at a tertiary teaching hospital. We included patients with sepsis or septic shock within 24 h of ICU admission. The RIC procedure comprised 3 cycles of brachial cuff inflation to 200 mmHg for 5 min followed by deflation to 0 mmHg for another 5 min. The procedure took 30 min. RIC was performed at the time of study inclusion and repeated after 12 and 24 h. Sublingual microcirculatory measurements were obtained before and after each RIC procedure using a Cytocam(®)-incident dark-field (IDF) device (Braedius Medical, Huizen, The Netherlands). The microcirculatory data were compared with a historical control. Data are reported as the medians along with the 25th and 75th percentiles. RESULTS: Twenty-six septic patients with a median age of 65 (57–81) years were enrolled in this study. The median Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at admission were 20 (13–23) and 10 (9–12), respectively. All patients were receiving vasopressors. After the 1st RIC procedure, the microvascular flow index (MFI) and the proportion of perfused vessels (PPV) among small vessels were significantly higher than before the procedure, with pre- and post-treatment values of 2.17 (1.81–2.69) and 2.59 (2.21–2.83), respectively, for MFI (p = 0.003) and 87.9 (82.4–93.8) and 92.5 (87.9–96.1) %, respectively, for PPV (p = 0.026). This result was confirmed by comparison with a historical control group. We found no change in microcirculatory flow or density parameters during repeated RIC after 12 h and 24 h. CONCLUSION: In patients with sepsis, the first remote ischemic conditioning procedure improved microcirculatory flow, whereas later procedures did not affect sublingual microcirculation. Trial registration NCT04644926, http://www.clinicaltrials.gov. Date of registration: 25 November 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04644926. Springer International Publishing 2021-04-07 /pmc/articles/PMC8025901/ /pubmed/33829305 http://dx.doi.org/10.1186/s13613-021-00848-y Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research
Kiudulaite, Inga
Belousoviene, Egle
Vitkauskiene, Astra
Pranskunas, Andrius
Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title_full Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title_fullStr Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title_full_unstemmed Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title_short Effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
title_sort effects of remote ischemic conditioning on microcirculatory alterations in patients with sepsis: a single-arm clinical trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025901/
https://www.ncbi.nlm.nih.gov/pubmed/33829305
http://dx.doi.org/10.1186/s13613-021-00848-y
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