Sublingual tissue perfusion improves during emergency treatment of acute decompensated heart failure

• Published in: The American journal of emergency medicine Vol. 30; no. 6; pp. 872 - 880
• Main Authors: Hogan, Christopher J., MD, Ward, Kevin R., MD, Franzen, Douglas S., MD, Rajendran, Bipin, BS, Thacker, Leroy R., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier; Elsevier Limited
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Circulation - physiology; Blood Pressure - physiology; Capillaries - physiopathology; Cardiovascular disease; Drug therapy; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Service, Hospital; Family medical history; Female; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Hemoglobins - analysis; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Male; Medical sciences; Middle Aged; Mouth Floor - blood supply; Natriuretic Peptide, Brain - blood; Prospective Studies; Studies; Time Factors; Heart failure; Intensive care; Treatment; Heart disease; Cardiovascular disease; Emergency; Sublingual; Resuscitation
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2011.06.005

Abstract Objectives The aim of this study was to measure sublingual perfused capillary density (PCD) to assess sublingual microvascular perfusion during emergency department (ED) treatment of acute decompensated heart failure (ADHF). Methods This prospective, observational study enrolled ED patients with ADHF, measuring pre- and post-ED treatment PCD. Sidestream dark-field imaging was analyzed by 3 investigators blinded to patient identifiers and time points. Patient demographics, ADHF etiology, serum brain natriuretic peptide, and hemoglobin were measured along with a visual analogue scale (VAS), which assessed patient baseline characteristics and response to ED treatment. A paired t test analyzed changes in PCD, mean arterial pressure (MAP), and patient assessment. Interrater variability was assessed with an intraclass correlation coefficient (ICC), with a P value <.05 considered significant for all testing. Results Thirty-six patients were enrolled with a mean time between pretreatment and posttreatment PCD (±SD) of 138 ± 59 minutes and a hospital length of stay of 4.0 ± 4.1 days. During this time, PCD increased (difference, 1.3 mm/mm2 ; 95% confidence interval, 0.4-2.1; P = .004), as did the MAP ( P = .002), patient VAS score ( P < .001), and observer VAS score ( P < .001). There was no correlation between the change in PCD and time ( R2 = .016, P = .47), MAP ( R2 = .013, P = .54), or VAS scores. The ICC was 0.954. Conclusions Sublingual tissue perfusion is diminished in ADHF but increases with treatment. It may represent a quantitative way to evaluate ADHF in the ED setting.