Preserved cerebral microcirculation during cardiogenic shock

Zhi Wan, Giuseppe Ristagno, Shijie Sun, Yongqin Li, Max Harry Weil, Wanchun Tang

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)2333-2337
Number of pages5
JournalCritical Care Medicine
Volume37
Issue number8
DOIs
Publication statusPublished - Aug 2009

Fingerprint

Cardiogenic Shock
Cheek
Microcirculation
Cardiac Output
Arterial Pressure
Stroke Volume
Sprague Dawley Rats
Aorta
Cerebrovascular Circulation
Parietal Lobe
Craniotomy
Tracheostomy
Pentobarbital
Thoracotomy
Heart Arrest
Shock
Anesthesia
Prospective Studies
Brain

Keywords

  • Buccal microcirculation
  • Cardiogenic shock
  • Cerebral microcirculation
  • Orthogonal polarization spectral imaging
  • Rat

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Preserved cerebral microcirculation during cardiogenic shock. / Wan, Zhi; Ristagno, Giuseppe; Sun, Shijie; Li, Yongqin; Weil, Max Harry; Tang, Wanchun.

In: Critical Care Medicine, Vol. 37, No. 8, 08.2009, p. 2333-2337.

Research output: Contribution to journalArticle

Wan, Zhi ; Ristagno, Giuseppe ; Sun, Shijie ; Li, Yongqin ; Weil, Max Harry ; Tang, Wanchun. / Preserved cerebral microcirculation during cardiogenic shock. In: Critical Care Medicine. 2009 ; Vol. 37, No. 8. pp. 2333-2337.
@article{945e3456dfdc4ce5a71d9a36dd633e43,
title = "Preserved cerebral microcirculation during cardiogenic shock",
abstract = "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.",
keywords = "Buccal microcirculation, Cardiogenic shock, Cerebral microcirculation, Orthogonal polarization spectral imaging, Rat",
author = "Zhi Wan and Giuseppe Ristagno and Shijie Sun and Yongqin Li and Weil, {Max Harry} and Wanchun Tang",
year = "2009",
month = "8",
doi = "10.1097/CCM.0b013e3181a3a97b",
language = "English",
volume = "37",
pages = "2333--2337",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Preserved cerebral microcirculation during cardiogenic shock

AU - Wan, Zhi

AU - Ristagno, Giuseppe

AU - Sun, Shijie

AU - Li, Yongqin

AU - Weil, Max Harry

AU - Tang, Wanchun

PY - 2009/8

Y1 - 2009/8

N2 - 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.

AB - 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.

KW - Buccal microcirculation

KW - Cardiogenic shock

KW - Cerebral microcirculation

KW - Orthogonal polarization spectral imaging

KW - Rat

UR - http://www.scopus.com/inward/record.url?scp=68249122114&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68249122114&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e3181a3a97b

DO - 10.1097/CCM.0b013e3181a3a97b

M3 - Article

C2 - 19487927

AN - SCOPUS:68249122114

VL - 37

SP - 2333

EP - 2337

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 8

ER -