- Author
-
Z. Uz
- Title
- Microcirculatory assessment in perioperative and critically ill patients
- Supervisors
-
T.M. van Gulik
C. Ince - Co-supervisors
-
B.A.J.M. de Mol
- Award date
- 1 July 2020
- Number of pages
- 326
- ISBN
- 9789463808309
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Bedside microcirculatory monitoring in surgical and critically ill patients was assessed in this thesis, to address the potential clinical feasibility and value of the handheld vital microscope (HVM) imaging. Different organ surfaces were investigated and explored using HVM imaging, in the sublingual space as well in distant organs as the liver, intestines and the peritoneum. Four different areas of investigation were targeted; 1) assessment of the microcirculatory leukocytes, 2) fluid management in the perioperative phase, 3) liver perfusion during liver resection, 4) morphological assessment of organ microcirculation in health and disease.
Microcirculatory monitoring by HVM is applied in cardiac surgery, liver surgery, in volunteer and rabbit studies. The following novel insights regarding the microcirculatory monitoring were revealed:
- Eye-balling is a possible observational evaluation to identify alterations in the microcirculation, especially when measured in one spot over a long period.
- New methodology has become available to identify microcirculatory leukocytes using the space-time diagram by HVM.
- The microvascular density should be used as a target parameter during fluid management.
- Hepatic microcirculatory changes occur during the atrophy-hypertrophy complex induced by portal vein embolization and during vascular inflow occlusion.
- Introduction of a new anatomy guided sublingual microcirculatory assessment using HVM.
The first steps are made in this thesis towards clinical use of HVM. However, future research needs to establish and validate these introduced microvascular parameters. There is a need for clearly defined targets as well as interventions targeting the microcirculation. - Persistent Identifier
- https://hdl.handle.net/11245.1/b02ce251-4ad0-4134-98ee-6278bf319f0a
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: The reaction of the sublingual microcirculation to SIRS after abdominal surgery: A case study
Chapter 3: Identification and quantification of human microcirculatory leukocytes in patients using handheld video microscopes at the bedside
Chapter 4: Leukocyte activation in the microcirculation during on-pump CABG surgery; Introduction of a new method to count the rolling leukocytes at the bedside
Chapter 5: Real-time observation of increased leukocyte activation in the sublingual and intestinal microcirculation of patients undergoing major liver resection
Chapter 6: Case report: Sublingual microcirculation reveals fluid overload and leukocytosis in a post-cardiac surgery patient
Chapter 7: Recruitment of sublingual microcirculation using hand held incident dark field imaging as a routine measurement tool during the postoperative de-escalation phase – A pilot study in post ICU cardiac surgery patients
Chapter 8: Goal directed fluid therapy during major liver resection shows altered sublingual and intestinal microcirculation when compared to low central venous pressure management: substudy of a surgeon- and patient-blinded randomized controlled trial
Chapter 9: Alterations in intestinal serosal microcirculation precipitated by the Pringle manoeuvre
Chapter 10: Interpatient heterogeneity in hepatic microvascular blood flow during vascular inflow occlusion (Pringle manoeuvre)
Chapter 11: Intraoperative imaging techniques to visualize hepatic (micro) perfusion: An overview
Chapter 12: Assessment of hepatic microvascular flow and density in patients undergoing preoperative portal vein embolization
Chapter 13: Quantitative assessment of liver function using hepatobiliary scintigraphy; Impact of microcirculatory alterations after portal vein embolization
Chapter 14: Increased hepatic microvascular density, oxygen pressure and VEGF in the hypertrophic lobe following portal vein embolization in rabbits
Chapter 15: Circulating microaggregates during CABG surgery precedes postoperative stroke
Chapter 16: Intraoperative incident dark field imaging of the human peritoneal microcirculation
Chapter 17: Identifying a sublingual triangle as the ideal site for assessment of sublingual microcirculation
Summary and future perspectives; Nederlandse samenvatting en toekomstperspectieven
List of publications; List of contributing authors; PhD portfolio
Dankwoord; Curriculum vitae
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