Sublingual microcirculation detects impaired perfusion in dehydrated older patients

Author:

Bruno Raphael Romano1,Masyuk Maryna1,Muessig Johanna M.1,Binneboessel Stephan1,Bernhard Michael2,Bäz Laura3,Franz Marcus3,Kelm Malte14,Jung Christian1

Affiliation:

1. Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany

2. Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany

3. Department of Internal Medicine I, University Hospital Jena, Jena, Germany

4. Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany

Abstract

BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.

Publisher

IOS Press

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine,Hematology,Physiology

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