Microcirculation in critically ill children

__Abstract__ The aims of this thesis were to assess the feasibility of orthogonal polarization spectral (OPS) imaging of the buccal microcirculation in children and to investigate the effect of disease and critical care treatments on microcirculatory hemodynamics. To fulfil these aims two groups of children were studied: those with presumably normal microcirculation and those who were critically ill with severe respiratory failure or with sepsis. Routine hemodynamic monitoring in critically ill pediatric patients has limitations. Restoration of global hemodynamics does not always mean that adequate regional tissue perfusion is achieved, especially in conditions of impaired autoregulation such as occurs during critical illness. The microcirculation is an essential hemodynamic compartment and as such plays an important role in (patho-) physiology of the circulation. Taken together, monitoring the microcirculation, possibly, could be a valuable addition to the hemodynamic monitoring of the critically ill pediatric patient

The microcirculation of the critically ill pediatric patient

textabstractNote: This article is one of eleven reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2011 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annual. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/890

Opheffen stoma bij IBD: niet zo eenvoudig:Behandeling van acute op chronische pijn

Chronisch inflammatoire darmziekte (inflammatory bowel disease, IBD) is een multifactoriële aandoening die ontstaat op basis van auto-immunologische ontsteking van de darmen. Veel patiënten met IBD hebben een verstoorde pijnperceptie en last van chronische pijn. Bij het plannen van de anesthesietechniek is een belangrijk uitgangspunt om zo opioïd-sparend mogelijk te werken, waardoor de darmmotiliteit zo min mogelijk onderdrukt wordt en geen opioïd-geïnduceerde hyperalgesie veroorzaakt wordt. Tevens moet de kans op het ontwikkelen en/of het verergeren van chronische pijn en/of een verlengde hospitalisatie zo klein mogelijk worden gehouden. Een locoregionale techniek in combinatie met verschillende co-analgetica en gebruik van niet-farmacologische anxiolytische en analgetische technieken zijn hierbij noodzakelijk.<br/

Functional capillary density decreases after the first week of life in term neonates

Background: Changes in the microcirculation have been recognized to play a crucial role in many disease processes. In premature neonates, functional capillary density (FCD) decreases during the first months of life. Objectives: The aims of this study were to obtain microcirculatory parameters in term neonates and older children who did not present with compromised respir

How Do We Treat Children with Anterior Cutaneous Nerve Entrapment Syndrome and Is the Biopsychosocial Model Also Being Applied? A Scoping Review

Background: Evidence-based guidelines for managing anterior cutaneous nerve entrapment syndrome (ACNES) in children are absent. The primary aim of this review was to scrutinize the evidence supporting currently used treatment interventions. In accordance with the World Health Organization (WHO) guidelines for managing chronic pain in children, these patients and their families and caregivers should be treated within the context of the biopsychosocial model; pain should not be treated purely as a biomedical problem. Therefore, our second aim was to evaluate whether these interventions are applied within the context of the biopsychosocial model, utilizing an inter- or multidisciplinary approach. Materials and Methods: A scoping review of the literature was conducted to explore treatment strategies for ACNES in children. To ensure a comprehensive overview of published literature on this topic, the search was not restricted based on study type. Two reviewers independently assessed titles and abstracts. After excluding records unrelated to children, full texts were screened for inclusion. Any discrepancies in judgement were resolved through discussion with a third reviewer. Results: Out of 35 relevant titles, 22 were included in this review. Only 4 articles provided information on long-term outcomes. The overall quality of the review was deemed low. The majority of reports did not address treatment or education within the psychological and social domains. A structural qualitative analysis was not feasible due to the substantial heterogeneity of the data. Conclusion: The evidence supporting current treatment strategies in children with ACNES is of low quality. More research is needed to establish an evidence-based treatment algorithm for patients with this challenging pain problem. In line with the WHO recommendation, greater emphasis should be placed on a biopsychosocial approach. The ultimate goal should be the development of a generic treatment algorithm outlining an approach to ACNES applicable to all professionals involved.</p

The Microcirculation Is Unchanged in Neonates with Severe Respiratory Failure after the Initiation of ECMO Treatment

Purpose. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. We tested the hypothesis that VA-ECMO therapy improves the microcirculation in neonates with severe respiratory failure. Methods. This single-center prospective observational pilot study took place in an intensive care unit of a level III university children's hospital. Twenty-one-term neonates, who received VA-ECMO treatment, were included. The microcirculation was assessed in the buccal mucosa, using Orthogonal Polarization Spectral imaging, within 24 hours before (T1) and within the first 24 hours after initiation of ECMO treatment (T2). Data were compared to data of a ventilated control group (N = 7). Results. At baseline (T1), median functional capillary density (FCD), microvascular flow index (MFI), and heterogeneity index (HI) did not differ between the ECMO group and the control group. At T2 the median FCD was lower in the control group (median [range]: 2.4 [1.4–4.2] versus 4.3 [2.8–7.4] cm/cm2; P value <0.001). For MFI and HI there were no differences at T2 between the two groups. Conclusion. The perfusion of the microcirculation does not change after initiation of VA-ECMO treatment in neonates with severe respiratory failure

Changes in buccal microcirculation following extracorporeal membrane oxygenation in term neonates with severe respiratory failure

Objectives: Extracorporeal membrane oxygenation (ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. In this study, we tested two hypotheses: 1) neonates with severe respiratory failure exhibit alterations of the microcirculation and 2) after ECMO therapy these microcirculatory alterations are improved. Design: Single-center prospective observational study. Setting: Intensive care unit of a level III university children's hospital. Patients: Term neonates receiving venoarterial ECMO. Control patients with and without respiratory failure. Measurements and Main Results: The microcirculation was assessed in the buccal mucosa, using orthogonal polarization spectral imaging, before and after ECMO. Functional capillary density was lower in patients with severe respiratory failure before ECMO (n = 14) compared with control patients (n = 10; p < 0.01). Functional capillary density had increased significantly after ECMO (p < 0.01). Conclusion: Microcirculatory parameters are depressed in neonates with severe respiratory failure and improve significantly following ECMO treatment. (Crit Care Med 2009; 37:1121-1124