Sublingual tissue perfusion improves during emergency treatment of acute decompensated heart failure

Objectives: The aim of this study was to measure sublingual perfused capillary density (PCD) to assess sublingual microvascular perfusion during emergency department (ED) treatment of acute decompensated heart failure (ADHF). Methods: This prospective, observational study enrolled ED patients with ADHF, measuring pre- and post-ED treatment PCD. Sidestream dark-field imaging was analyzed by 3 investigators blinded to patient identifiers and time points. Patient demographics, ADHF etiology, serum brain natriuretic peptide, and hemoglobin were measured along with a visual analogue scale (VAS), which assessed patient baseline characteristics and response to ED treatment. A paired t test analyzed changes in PCD, mean arterial pressure (MAP), and patient assessment. Interrater variability was assessed with an intraclass correlation coefficient (ICC), with a P value <.05 considered significant for all testing. Results: Thirty-six patients were enrolled with a mean time between pretreatment and posttreatment PCD (+/- SD) of 138 +/- 59 minutes and a hospital length of stay of 4.0 +/- 4.1 days. During this time, PCD increased (difference, 1.3 mm/mm(2); 95% confidence interval, 0.4-2.1; P = .004), as did the MAP (P = .002), patient VAS score (P < .001), and observer VAS score (P < .001). There was no correlation between the change in PCD and time (R-2 =.016, P = .47), MAP (R-2 = .013, P = .54), or VAS scores. The ICC was 0.954. Conclusions: Sublingual tissue perfusion is diminished in ADHF but increases with treatment. It may represent a quantitative way to evaluate ADHF in the ED setting. (C) 2011 Published by Elsevier Inc.