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Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-9663-3720
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Department of Dermatology, Södra Älvsborgs Sjukhus, Borås, Sweden.ORCID iD: 0000-0002-2027-1663
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
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2014 (English)In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, 761-771 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014. Vol. 21, no 8, 761-771 p.
Keyword [en]
Pressure ulcer, photoplethysmography, laser Doppler flowmetry, non-invasive, tissue blood flow
National Category
Nursing Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-109950DOI: 10.1111/micc.12160ISI: 000344789400010PubMedID: 25100630OAI: oai:DiVA.org:liu-109950DiVA: diva2:741848
Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure
Open this publication in new window or tab >>Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to combine optical methods into a system with the ability to simultaneously measure blood flow changes at different tissue depths. The goal of such a system was to reveal vascular mechanisms relevant to pressure ulcer etiology under clinically relevant conditions and in relation to the evaluation of pressure-redistribution support surfaces.

This thesis consists of four quantitative, cross-sectional studies measuring blood flow responses before, during, and after pressure exposure of the sacral tissue. Two optical methods – photoplethysmography and laser Doppler flowmetry – were combined in a newly developed system that has the ability to discriminate blood flows at different tissue depths. Studies I and II explored blood flow responses at different depths in 17 individuals. In Study I the blood flow was related to tissue thickness and tissue compression during pressure exposure of ≥ 220 mmHg. In Study II, the sacral tissue was loaded with 37.5 mmHg and 50.0 mmHg, and the variation in blood flow was measured. Studies III and IV included 42 healthy individuals < 65 years, 38 healthy individuals ≥ 65 years, and 35 patients ≥ 65 years. Study III included between-subject comparisons of blood flow and pressure between individuals in the three study groups lying in supine positions on a standard hospital mattress. Study IV added within-subject comparisons while the individual was lying on four different types of mattress. The studies explored the vascular phenomena pressure-induced vasodilation (PIV) and reactive hyperemia (RH).

The most common blood flow response to tissue exposure in this thesis was PIV, although a decrease in blood flow (a lack of PIV) was observed in some individuals. The patients tended to have higher interface pressure during pressure exposure than the healthy groups but no differences in blood flow responses were seen. Our results showed that pressure levels that are normally considered to be harmless could have a significant effect on the microcirculation in different tissue structures. Differences in individual blood flow responses in terms of PIV and RH were seen, and a larger proportion of individuals lacked these responses in the deeper tissue structures compared to more superficial tissue structures.

This thesis identified PIV and RH that are important vascular mechanisms for pressure ulcer development and revealed for the first time that PIV and RH are present at different depths under clinically relevant conditions. The thesis also identified a population of individuals not previously identified who lack both PIV and RH and seem to be particularly vulnerable to pressure exposure. Further, this thesis has added a new perspective to the microcirculation in pressure ulcer etiology in terms of blood flow regulation and endothelial function that are anchored in clinically relevant studies. Finally, the evaluation of pressureredistribution support surfaces in terms of mean blood flow during and after tissue exposure was shown to be unfeasible, but the assessment of PIV and RH could provide a new possibility for measuring individual physiological responses that are known to be related to pressure ulcer development.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 80 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1407
Keyword
Pressure ulcer, photoplethysmography, laser Doppler flowmetry, non-invasive, tissue blood flow, reactive hyperemia, pressure-induced vasodilation, interface pressure, risk assessment
National Category
Nursing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109960 (URN)10.3384/diss.diva-109960 (DOI)978-91-7519-317-5 (ISBN)
Public defence
2014-09-12, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2014-08-29Bibliographically approved

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Bergstrand, SaraKällman, UlrikaEk, Anna-ChristinaLindberg, Lars-GöranEngström, MariaSjöberg, FolkeLindgren, Margareta

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Bergstrand, SaraKällman, UlrikaEk, Anna-ChristinaLindberg, Lars-GöranEngström, MariaSjöberg, FolkeLindgren, Margareta
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Division of Nursing ScienceFaculty of Health SciencesDepartment of Acute Health Care in LinköpingThe Institute of TechnologyPhysiological MeasurementsDivision of Radiological SciencesCenter for Medical Image Science and Visualization (CMIV)Division of Clinical SciencesDepartment of Hand and Plastic SurgeryDepartment of Anaesthesiology and Intensive Care in Linköping
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