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Published on: December 10, 2020
The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial
Banu Kilicaslan1, Ozgur Canbay1, Alev Saylan1
1Department of Anesthesiology and Intensive Care.
Insights
Blood transfusions can improve capillary perfusion in children undergoing surgery, but do not always restore baseline microcirculation. Bedside microvascular analysis may aid intraoperative bleeding management in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Vascular Biology
Background:
- Perioperative bleeding management in children presents unique challenges.
- Microvascular imaging offers insights into blood transfusion effects, yet data in pediatric populations are limited.
Purpose of the Study:
- To investigate the impact of blood management strategies on macro- and micro-hemodynamic parameters in pediatric patients undergoing craniofacial surgery.
- To assess the correlation between microvascular changes and systemic parameters following blood transfusion.
Main Methods:
- Prospective observational study with repeated measurements in 14 children undergoing craniofacial surgery.
- Evaluation of total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, hematocrit, lactate, mixed venous oxygen saturation, electrolytes, heart rate, mean arterial blood pressure) at baseline, post-bleeding, and post-operation.
- Blood transfusion indications included low hemoglobin/hematocrit, altered tissue perfusion, and impaired microcirculation.
Main Results:
- Ten of 14 patients received blood transfusions. Capillary perfusion significantly improved post-transfusion (P < 0.05), but only 6 patients reached baseline levels.
- Blood transfusions increased hematocrit (P < 0.05), yet no significant correlation was found between microvascular changes and systemic hemodynamic or tissue perfusion parameters.
- Sublingual microcirculation showed changes post-transfusion, but these changes did not correlate with systemic hemodynamics, tissue perfusion, or hematocrit values.
Conclusions:
- Blood transfusion can enhance microcirculatory parameters in pediatric surgical patients, but complete restoration to baseline may not occur.
- Current systemic hemodynamic and biochemical monitoring, alongside hematocrit, may not fully capture the microcirculatory response to transfusion.
- Bedside microvascular analysis, integrated with standard monitoring, holds potential for optimizing fluid and blood therapy during intraoperative bleeding in children.
Abstract:
Perioperative management of bleeding in children can be challenging. Microvascular imaging techniques have allowed evaluating the effect of blood transfusion on the microcirculation, but little is known about these effects in children. We aimed to investigate the effects of blood management using macro- and micro-hemodynamic parameters measurement in children undergoing craniofacial surgery. This is a prospective observational repeated measurement study including fourteen children. The indications for blood transfusion were changes of hemoglobin/hematocrit (Hct) levels, the presence of signs of altered tissue perfusion and impaired microcirculation images. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, Hct, lactate, mixed venous oxygen saturation, K+, heart rate, mean arterial blood pressure) were evaluated baseline (T1), at the end of the surgical bleeding (T2) and end of the operation (T3). Four patients did not need a blood transfusion. In the other 10 patients who received a blood transfusion, capillary perfusion was higher at T3 (13[9-16]) when compared with the values of at T2 (11[8-12]) (P < 0.05) but only 6 patients reached their baseline values. Although blood transfusions increased Hct values (17 ± 2.4 [T2]-19 ± 2.8 [T3]) (P < 0.05), there was no correlation between microvascular changes and systemic hemodynamic parameters (P > 0.05). The sublingual microcirculation could change by blood transfusion but there was not any correlation between microcirculation changes, hemodynamic, and tissue perfusion parameters even with Hct values. The indication, guidance, and timing of fluid and blood therapy may be assessed by bedside microvascular analysis in combination with standard hemodynamic and biochemical monitoring for intraoperative bleeding in children.
