Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Alexandros Rovas, Laura Mareen Seidel, Hans Vink, Timo Pohlkoetter, Hermann Pavenstaedt, Christian Ertmer, Michael Hessler, Philipp Kuempers*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BackgroundThe endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis.MethodsThis observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck (TM)). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values.ResultsIn septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p=0.002; PPV, 98.53 vs 92.58, p=0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p

Original languageEnglish
Article number260
Number of pages11
JournalCritical Care
Publication statusPublished - 24 Jul 2019


  • Endothelial glycocalyx
  • Microcirculation
  • Perfused boundary region
  • PBR
  • Intravital microscopy
  • Sepsis
  • Intensive care unit
  • Sidestream dark field microscopy
  • Incident dark field illumination imaging
  • Glycosaminoglycans
  • RISK
  • TIME

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