• Diego Orbegozo, Gianni Stringari, Rafael Damazio, Daniel De Backer, Jean-Louis Vincent, and Jacques Creteur.
• Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 268426922684-2692.

ObjectivesTo assess microvascular reactivity during a skin thermal challenge early post-cardiac surgery and its association with outcomes.DesignNoninvasive physiological study.SettingThirty-five-bed department of intensive care.ParticipantsPatients admitted to the intensive care unit post-cardiac surgery.InterventionsThermal challenge.Measurements And Main ResultsA total of 46 patients were included; 14 needed vasoactive or ventilatory support for at least 48 hours (slow recovery), and 32 had a more rapid recovery. Skin blood flow (SBF) was measured on the anterior proximal forearm using skin laser Doppler. A thermal challenge was performed by abruptly increasing local skin temperature from 37°C to 43°C while monitoring SBF. The ratio between SBFs at 43°C and 37°C was calculated to measure microvascular reactivity. SBF at 37°C was not significantly different in patients with a slow recovery and those with a rapid recovery, but SBF after 9 minutes at 43°C was lower (48.5 [17.3-69.0] v 85.1 [45.2-125.7], p < 0.01), resulting in a lower SBF ratio (2.8 [1.5-4.7] v 4.8 [3.7-7.8], p < 0.01). Patients with lower SBF ratios were more likely to have dysfunction of at least one organ (assessed using the sequential organ dysfunction score) 48 hours post-cardiac surgery than those with higher ratios: 88% versus 40% versus 27% (p < 0.01), respectively, for the lowest, middle, and highest tertiles of SBF ratio. In multivariable analysis, a lower SBF ratio was an independent risk factor for slow recovery.ConclusionsEarly alterations in microvascular reactivity, evaluated by a skin thermal challenge, are correlated with organ dysfunction. These observations may help in the development of new, simple, noninvasive monitoring systems in postoperative patients.Copyright © 2024 Elsevier Inc. All rights reserved.

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