Assessing damage to microcirculation during meningococcal septicaemia.
How malfunction of the smallet blood vessels causesorgan failure
Dr Alistair Thomson, Dr Andrew Riordan, Dr Enitan Carrol, Dr Fauzia Paize, Dr Niten Makwana, Dr Paul Baines, Dr Richard Sarginson, Professor C Anthony Hart
- Start Date:
01 January 2006
Alderhey Children's Hospital, Liverpool, UK, Institute of Child Health, London, UK, Liverpool University, Liverpool, UK
In meningococcal septicaemia, bacteria multiply and release toxins, causing inflammation within blood vessel walls, which leads to shock. Unless this process can be reversed by prompt medical treatment, the circulation shuts down, ending in vital organ failure and death. The microcirculation consists of the smallest vessels, called capillaries, which deliver oxygen and nutrients to cells. In adults with septicaemia it has been shown that microcirculatory malfunction is the cause of organ failure. Direct observation of the effects of shock or its treatment on the microcirculation in children has not been possible previously; it has only been possible to measure the effects of treatment on the larger vessels indirectly. The microcirculation can now be investigated directly using orthogonal polarisation spectral (OPS) imaging. This is an instrument that enables doctors to look at the circulation in the smallest vessels to determine blood flow. The advantage of OPS imaging is that it does not require any surgical insertion. The project aims to assess changes in the microcirculation in children with meningococcal disease, to determine if microcirculatory disturbances are greatest in children who are sickest and to compare OPS imaging to current measures of circulatory function. Finally, researchers will correlate OPS imaging with molecules that are responsible for maintaining the function of the lining of the capillary wall. This understanding will assist identification of microcirculatory abnormalities, the effect of treatments on these abnormalities, and enable early-targeted interventions before irreversible damage ensues, with consequent improvements in patient outcome.