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Conjunctival and sublingual microcirculation alterations in head trauma patients with increased intracranial pressure

Introduction

Both the conjunctiva and the sublingual tissue have a common blood supply via the common carotid artery trunk. Moreover, the conjunctiva receives blood from the internal carotid artery and the sublingual tissue receives from the external carotid artery. We hypothesized that conjunctival and sublingual microcirculation can be used to evaluate intracranial and extracranial perfusion and to monitor therapy to improve cerebral perfusion pressure in patients after head trauma.

Methods

In three groups of patients with increased intracranial pressure (ICP) (high ICP > 30, medium ICP 20–30 and low ICP < 20) following head trauma, both the conjunctival and sublingual microcirculation was measured using sidestream darkfield imaging (MicroScan®; MicroVision Medical, The Netherlands) to evaluate intracranial and extracranial perfusion. Using microvascular analysis software (MAS®; MicroVision Medical), functional density of small (<20 μm), medium (20–50 μm) and large (>50 μm) microvessels were determined in addition to erythrocyte velocities.

Results

Conjunctival microcirculatory flow was intermittent in patients with highest ICP, low-continuous in patients with medium ICP, and normal-continuous in patients with lowest ICP. Intracranial perfusion pressure was lowest in patients with highest ICP and vice versa. Functional vessel densities in the conjuctiva were in the same range in all three groups. However, the sublingual functional capillary densities were consistently lower in all groups as compared with controls, suggesting an active intracranial and extracranial regional autoregulation.

Conclusion

Conjunctival microcirculatory flow analysis reflects alterations in cranial perfusion pressure and might be a possible noninvasive endpoint to monitor cerebral perfusion and therapy.

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Atasever, B., Gommers, D. & Bakker, J. Conjunctival and sublingual microcirculation alterations in head trauma patients with increased intracranial pressure. Crit Care 11, P355 (2007). https://doi.org/10.1186/cc5515

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Keywords

  • Cerebral Perfusion Pressure
  • Functional Capillary Density
  • Sidestream Darkfield
  • Sublingual Microcirculation
  • Microcirculation Alteration