Journal of cardiothoracic and vascular anesthesia · 2026
Assessment of Microcirculation and Microcirculatory Function During Cardiopulmonary Bypass Using Hyperspectral Imaging and a Vascular Occlusion Test: An Observational Pilot Study.
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Arends Sven, Murmann Alexa Margaux, Mavarani Laven, Schmidt Börge, Shehada Sharaf-Eldin, Haddad Ali, Brenner Thorsten, Schmidt Karsten
Аннотация
OBJECTIVES: To evaluate perioperative changes in cutaneous microcirculation and microvascular reactivity using hyperspectral imaging (HSI) with a standardized vascular occlusion test (VOT) in cardiac surgery with cardiopulmonary bypass (CPB), and to explore associations with vasoactive support, systemic markers, and outcomes.
DESIGN: Prospective, monocentric, hypothesis-generating observational pilot study.
SETTING: Single-center university hospital.
PARTICIPANTS: Twenty-nine adults undergoing elective cardiac surgery with CPB, of whom 25 with complete datasets were analyzed.
INTERVENTIONS: Palmar HSI (TIVITA tissue) before induction (T0), after induction (T1) and after skin closure (T2), yielding tissue oxygenation (StO₂) and near-infrared perfusion index (NPI) data. A standardized VOT (5-minute arterial occlusion) at T1 and T2 assessed reactive hyperemia amplitude and time to peak (PORH_ttp).
MEASUREMENTS AND MAIN RESULTS: A total of 600 HSI measurements were obtained. StO₂ and NPI values were increased after induction and decreased at T2 despite stable macrocirculation, with no correlation with macrocirculatory variables. At T2, StO₂ correlated negatively with norepinephrine equivalents (r = -0.43), lactate (r = -0.61), procalcitonin (r = -0.67) and CPB time (r = -0.65), whereas associations with interleukin-6 and syndecan-1 were weak. After CPB, the hyperemic StO₂ amplitude was preserved (Δ +30% v +31%), whereas the NPI response was markedly attenuated (Δ +12 AU v +28 AU) and PORH_ttp was prolonged (71.6 ± 36.5 s v 46.3 ± 17.6 s). Three patients requiring mechanical circulatory support showed lower HSI values and worse outcomes.
CONCLUSIONS: HSI-based VOT detected microcirculatory alterations after CPB-preserved superficial oxygenation amplitude with blunted deeper perfusion and delayed reactive hyperemia-that static HSI parameters alone did not capture. These hypothesis-generating findings require prospective validation before HSI can complement established hemodynamic monitoring.
DESIGN: Prospective, monocentric, hypothesis-generating observational pilot study.
SETTING: Single-center university hospital.
PARTICIPANTS: Twenty-nine adults undergoing elective cardiac surgery with CPB, of whom 25 with complete datasets were analyzed.
INTERVENTIONS: Palmar HSI (TIVITA tissue) before induction (T0), after induction (T1) and after skin closure (T2), yielding tissue oxygenation (StO₂) and near-infrared perfusion index (NPI) data. A standardized VOT (5-minute arterial occlusion) at T1 and T2 assessed reactive hyperemia amplitude and time to peak (PORH_ttp).
MEASUREMENTS AND MAIN RESULTS: A total of 600 HSI measurements were obtained. StO₂ and NPI values were increased after induction and decreased at T2 despite stable macrocirculation, with no correlation with macrocirculatory variables. At T2, StO₂ correlated negatively with norepinephrine equivalents (r = -0.43), lactate (r = -0.61), procalcitonin (r = -0.67) and CPB time (r = -0.65), whereas associations with interleukin-6 and syndecan-1 were weak. After CPB, the hyperemic StO₂ amplitude was preserved (Δ +30% v +31%), whereas the NPI response was markedly attenuated (Δ +12 AU v +28 AU) and PORH_ttp was prolonged (71.6 ± 36.5 s v 46.3 ± 17.6 s). Three patients requiring mechanical circulatory support showed lower HSI values and worse outcomes.
CONCLUSIONS: HSI-based VOT detected microcirculatory alterations after CPB-preserved superficial oxygenation amplitude with blunted deeper perfusion and delayed reactive hyperemia-that static HSI parameters alone did not capture. These hypothesis-generating findings require prospective validation before HSI can complement established hemodynamic monitoring.