| Preserved cerebral microcirculation during cardiogenic shock. | |
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MedLine Citation:
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PMID: 19487927 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To hypothesize that in severe states of cardiogenic shock with profound decreases in buccal microcirculation, the cerebral microcirculation may be selectively protected. Decreases in buccal microcirculatory flow are closely associated with the severity and outcomes of circulatory shock. DESIGN: We investigated the concurrent changes in cerebral and buccal microcirculation, in a rat model of cardiogenic shock caused by left ventricular failure. DESIGN: Randomized prospective animal study. SETTING: University-affiliated animal research laboratory. SUBJECTS: Sprague-Dawley rats. INTERVENTIONS: Studies were performed in ten male Sprague-Dawley rats, weighing between 450 and 550 g. After intraperitonial pentobarbital anesthesia and tracheostomy, a craniotomy exposed the parietal cortex for visualization of microcirculation. Animals then underwent thoracotomy and banding of ascending aorta producing left ventricular failure and cardiogenic shock. MEASUREMENTS AND MAIN RESULTS: Over a 4-hr interval, effects on arterial pressure, cardiac output, left ventricular end-diastolic volume, and ejection fractions were measured. The cerebral and buccal microcirculations were visualized concurrently with the aid of orthogonal polarization spectral imaging. Animals were randomized to identically treated controls in which the aorta was not ligated. Mean arterial pressure, cardiac output, and ejection fraction decreased strikingly and end-diastolic left ventricular volume more than doubled within 30 mins after aortic banding. The buccal microcirculation was concurrently reduced. However, cerebral microcirculatory flow was fully preserved. CONCLUSIONS: In contrast to striking reduction in cardiac output and arterial pressures together with buccal microcirculatory flow, cerebral cortical microcirculatory flow was fully preserved during cardiogenic shock. These findings further document a dissociation between the systemic and cerebral circulations and potentially explain earlier clinical and experimental observations that the brain is selectively protected during severe states of cardiogenic shock in the absence of cardiac arrest. |
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Authors:
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Zhi Wan; Giuseppe Ristagno; Shijie Sun; Yongqin Li; Max Harry Weil; Wanchun Tang |
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Publication Detail:
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Type: Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 37 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-07-17 Completed Date: 2009-08-11 Revised Date: 2009-12-29 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2333-7 Citation Subset: AIM; IM |
Affiliation:
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Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA. drsheart@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Cerebrovascular Circulation* Male Microcirculation* Mouth Mucosa / blood supply* Photomicrography Prospective Studies Random Allocation Rats Rats, Sprague-Dawley Shock, Cardiogenic / physiopathology* |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Jan;38(1):348-9
[PMID:
20023509
]
Crit Care Med. 2009 Aug;37(8):2470-1 [PMID: 19609116 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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