• John C Greenwood, David H Jang, Stephen D Hallisey, Jacob T Gutsche, Jiri Horak, Michael A Acker, Christian A Bermudez, Victoria L Zhou, Shampa Chatterjee, Frances S Shofer, Todd J Kilbaugh, AugoustidesJohn G TJGTDepartment of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA., Nuala J Meyer, Jan Bakker, and Benjamin S Abella.
• Division of Critical Care Medicine, Department of Emergency Medicine, Department of Anesthesiology and Critical Care, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: john.greenwood@pennmedicine.upenn.edu.
• J. Cardiothorac. Vasc. Anesth. 2021 Jan 1; 35 (1): 106115106-115.

ObjectiveResuscitation after cardiac surgery needs to address multiple pathophysiological processes that are associated with significant morbidity and mortality. Functional microcirculatory derangements despite normal systemic hemodynamics have been previously described but must be tied to clinical outcomes. The authors hypothesized that microcirculatory dysfunction after cardiac surgery would include impaired capillary blood flow and impaired diffusive capacity and that subjects with the lowest quartile of perfused vessel density would have an increased postoperative lactate level and acute organ injury scores.DesignProspective, observational study.SettingA single, tertiary university cardiovascular surgical intensive care unit.Participants25 adults undergoing elective cardiac surgery requiring cardiopulmonary bypass.InterventionSublingual microcirculation was imaged using incident dark field microscopy before and 2 to 4 hours after surgery in the intensive care unit.Measurements And Main ResultsCompared with baseline measurements, postoperative vessel-by-vessel microvascular flow index (2.9 [2.8-2.9] v 2.5 [2.4-2.7], p < 0.0001) and perfused vessel density were significantly impaired (20.7 [19.3-22.9] v 16.3 [12.8-17.9], p < 0.0001). The lowest quartile of perfused vessel density (<12.8 mm/mm2) was associated with a significantly increased postoperative lactate level (6.0 ± 2.9 v 1.8 ± 1.2, p < 0.05), peak lactate level (7.6 ± 2.8 v 2.8 ± 1.5, p = 0.03), and sequential organ failure assessment (SOFA) score at 24 and 48 hours.ConclusionIn patients undergoing cardiac surgery, there was a significant decrease in postoperative microcirculatory convective blood flow and diffusive capacity during early postoperative resuscitation. Severely impaired perfused vessel density, represented by the lowest quartile of distribution, is significantly related to hyperlactatemia and early organ injury.Copyright © 2020 Elsevier Inc. All rights reserved.

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