Assessment of endothelial cell function and physiological microcirculatory reserve by video microscopy using a topical acetylcholine and nitroglycerin challenge.

Hilty, Matthias Peter; Pichler Hefti, Jacqueline Renée; Ergin, Bulent; Hefti, Urs; Merz, Tobias; Ince, Can; Maggiorini, Marco (2017). Assessment of endothelial cell function and physiological microcirculatory reserve by video microscopy using a topical acetylcholine and nitroglycerin challenge. Intensive care medicine experimental, 5(1), p. 26. Springer 10.1186/s40635-017-0139-0

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BACKGROUND Assessment of the microcirculation is a promising target for the hemodynamic management of critically ill patients. However, just as the sole reliance on macrocirculatory parameters, single static parameters of the microcirculation may not represent a sufficient guide. Our hypothesis was that by serial topical application of acetylcholine (ACH) and nitroglycerin (NG), the sublingual microcirculation can be challenged to determine its endothelial cell-dependent and smooth muscle-dependent physiological reserve capacity. METHODS In 41 healthy subjects, sublingual capillary microscopy was performed before and after topical application of ACH and NG. Total vessel density (TVD) was assessed in parallel using manual computer-assisted image analysis as well as a fully automated analysis pathway utilizing a newly developed computer algorithm. Flow velocity was assessed using space-time diagrams of the venules as well as the algorithm-based calculation of an average perfused speed indicator (APSI). RESULTS No change in all measured parameters was detected after sublingual topical application of ACH. Sublingual topical application of NG however led to an increase in TVD, space-time diagram-derived venular flow velocity and APSI. No difference was detected in heart rate, blood pressure, and cardiac output as measured by echocardiography, as well as in plasma nitric oxide metabolite content before and after the topical application of ACH and NG. CONCLUSIONS In healthy subjects, the sublingual microcirculatory physiological reserve can be assessed non-invasively by topical application of nitroglycerin without affecting systemic circulation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Pichler Hefti, Jacqueline Renée and Merz, Tobias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2197-425X

Publisher:

Springer

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

19 Sep 2017 10:17

Last Modified:

18 Jan 2018 12:03

Publisher DOI:

10.1186/s40635-017-0139-0

PubMed ID:

28523563

Uncontrolled Keywords:

Endothelial cell function Hemodynamic monitoring Incident dark field Microcirculation Vasodilator Video microscopy

BORIS DOI:

10.7892/boris.101313

URI:

https://boris.unibe.ch/id/eprint/101313

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