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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Leukocytes influence peripheral tissue oxygenation and perfusion in neonates

Abstract

Background. Leukocyte counts may influence peripheral (micro) circulation due to changes in rheology. The aim of this study was to investigate a possible association between leukocyte counts and peripheral tissue oxygenation/perfusion measured with near infrared spectroscopy (NIRS) in term and preterm neonates.

Methods. In this observational study we included term and preterm neonates within the first 2 months of life, in whom peripheral tissue NIRS measurements were performed and blood samples (leukocytes and C reactive protein (CRP)) taken to investigate clinical signs of infection. Tissue-oxygenation index (TOI), fractional oxygen extraction (FTEO), oxygen delivery (DO2), oxygen consumption (VO2) and vascular resistance (VR) were measured by NIRS and venous occlusion method. TOI, FTOE, DO2, VO2 and VR were correlated to leukocyte counts on the same day and maximal CRP levels within 24 hours (CRP max).

Results. In 180 infants, with a mean gestational age of 35.5±3.3 weeks, leukocyte counts were 16546± 8830/µl (median 14830; range 1790 to 67840) and CRP max was 8.0± 19.0 mg/l (median 0.0; range 0.0 to 110.0mg/l).

TOI was 71.1±5.5%, FTOE 28.5±6.1%, DO2 46.7±19.7, VO2 12.5±4.4 and VR 11.7±6.4.

Leukocyte counts correlated negatively (r= -0.21; p= 0.005) with TOI and positively (r=0.17; p=0.029) with VR. Correlations with CRP max did not reach significance.

Conclusion. We demonstrated that peripheral tissue oxygen consumption decreases and vascular resistance increases with increasing leukocyte counts.

Key words: near-infrared spectroscopy, neonate, microcirculation, leukocytes.

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The endocannabinoid system in sepsis – a potential target to improve microcirculation?

Abstract

During the last decade, research has identified the endocannabinoid system (ECS) as a key regulator of essential physiological functions, including the regulation of microvascular and immune function. Indeed, increasing evidence now suggests that release of endocannabinoids and activation of cannabinoid receptors occurs during sepsis and that manipulation of the ECS may represent an important therapeutic target to improve microcirculation in sepsis. In this review, the pharmacology and physiology of the ECS and the involvement of cannabinoids, cannabinoid receptors and non-CB1R/CB2R pathways related to ECS activation will be described. This information will increase our comprehension of the role of lipid signaling pathways in sepsis and may lead to the identification of new drug targets for the treatment of impaired microcirculation.

Key words: systemic inflammation, sepsis, microcirculation, lipid mediators, cannabinoids, cannabinoid receptors

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