• Liver Int. · Mar 2010

    A study of muscle tissue oxygenation and peripheral microcirculatory dysfunction in cirrhosis using near infrared spectroscopy.

    • Sam J Thomson, Matthew L Cowan, Daniel M Forton, Sarah J Clark, Saif Musa, Michael Grounds, and Tony M Rahman.
    • Department of Gastroenterology and Hepatology, St George's Hospital, London, UK. sthomson@sgul.ac.uk
    • Liver Int. 2010 Mar 1;30(3):463-71.

    BackgroundThe circulatory dysfunction associated with cirrhosis is well described. Reduced systemic vascular resistance and high cardiac output are the main features of the hyperdynamic state, but involvement of the peripheral microcirculation in this process is poorly understood. Near infrared spectroscopy (NIRS) has been used to assess muscle tissue oxygenation (StO(2)) in haemorrhagic and septic shock. Vascular occlusion testing (VOT) can produce dynamic changes in StO(2) which represent tissue oxygen extraction, delivery, and hence, surrogate markers of microvascular function.AimsWe aimed to investigate dynamic StO(2) changes in the peripheral microcirculation of patients with cirrhosis.MethodsThirty-five subjects were examined (25 cirrhosis, 10 healthy volunteers) with an InSpectra 650 StO(2) monitor and 15 mm thenar probe. Brachial VOT was applied at systolic blood pressure +50 mmHg for 3 min, in triplicate. Dynamic StO(2) parameters are reported for baseline, downslope, upslope, area over ischaemic curve, overshoot, area under recovery curve and recovery time.ResultsPatients with cirrhosis demonstrated significantly larger post-occlusive hyperaemic variables compared with volunteers: overshoot (17 vs 15%, P=0.009), area under recovery curve (25.1 vs 16.3 %/min, P<0.001) and recovery time (3.0 vs 2.2 min, P<0.001). Magnitude of change was also seen to increase with disease stage as defined by Child-Pugh score. Serial VOT revealed microcirculatory ischaemic adaptation in volunteers, which was absent in cirrhosis.ConclusionsNIRS can identify dynamic changes in muscle tissue oxygenation in cirrhosis which are compatible with microcirculatory vasodilatation. Ischaemic adaptation was seen in controls but not in patients with cirrhosis. NIRS techniques offer a novel approach to the assessment of peripheral vascular dysfunction in cirrhosis.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…