Changes in sublingual microcirculatory flow index and vessel density on ascent to altitude

Daniel S. Martin, Peter Goedhart, Andre Vercueil, Can Ince, Denny Z.H. Levett, Mike P.W. Grocott

Research output: Contribution to journalArticlepeer-review

Abstract

<jats:p><jats:bold>We hypothesized that ascent to altitude would result in reduced sublingual microcirculatory flow index (MFI) and increased vessel density. Twenty‐four subjects were studied using sidestream dark‐field imaging, as they ascended to 5300 m; one cohort remained at this altitude (<jats:italic>n</jats:italic>= 10), while another ascended higher (maximum 8848 m; <jats:italic>n</jats:italic>= 14). The MFI, vessel density and grid crossings (GX; an alternative density measure) were calculated. Total study length was 71 days; images were recorded at sea level (SL), Namche Bazaar (3500 m), Everest base camp (5300 m), the Western Cwm (6400 m), South Col (7950 m) and departure from Everest base camp (5300 m; 5300 m‐b). Peripheral oxygen saturation</jats:bold>  <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/EPH_798_mu1.gif" xlink:title="inline image" />, <jats:bold>heart rate and blood pressure were also recorded. Compared with SL, altitude resulted in reduced sublingual MFI in small (&lt;25 μm; <jats:italic>P</jats:italic> &lt; 0.0001) and medium vessels (26–50 μm; <jats:italic>P</jats:italic>= 0.006). The greatest reduction in MFI from SL was seen at 5300 m‐b; from 2.8 to 2.5 in small vessels and from 2.9 to 2.4 in medium‐sized vessels. The density of vessels &lt;25 μm did not change during ascent, but those &gt;25 μm rose from 1.68 (± 0.43) mm mm<jats:sup>−2</jats:sup> at SL to 2.27 (± 0.57) mm mm<jats:sup>−2</jats:sup> at 5300 m‐b (<jats:italic>P</jats:italic>= 0.005); GX increased at all altitudes (<jats:italic>P</jats:italic> &lt; 0.001). The reduction in MFI was greater in climbers than in those who remained at 5300 m in small and medium‐sized vessels (<jats:italic>P</jats:italic>= 0.017 and <jats:italic>P</jats:italic>= 0.002, respectively). At 7950 m, administration of supplemental oxygen resulted in a further reduction of MFI and increase in vessel density. Thus, MFI was reduced whilst GX increased in the sublingual mucosa with prolonged exposure to hypoxia and was exaggerated in those exposed to extreme altitude.</jats:bold></jats:p>
Original languageEnglish
Pages (from-to)880-891
Number of pages0
JournalExperimental Physiology
Volume95
Issue number8
Early online date9 Jul 2010
DOIs
Publication statusPublished - Aug 2010

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