Changes in subcutaneous interstitial fluid pressure, tissue oxygenation, and skin red cell flux during venous congestion plethysmography in men

Objective: Venous congestion plethysmography enables noninvasive assessment of microvascular filtration capacity (K-f) in limbs. However, increases in fluid filtration might alter the balance of Starling forces; for example, progressive increases in interstitial fluid pressure (P-i) would It duce net fluid flux, thus underestimating K-f. Furthermore, elevation of cuff pressure to values close to diastolic blood pressure. as used in the protocol, may by itself impair tissue perfusion with unknown effects on the microvascular parameters investigated. Methods: P-i was measured in healthy volunteers (n = 14) with a modified ''Wick in needle'' technique during small (8 mm Hg) cumulative increases in venous pressure (0-95 mm Hg). Changes in the hemoglobin (Hb) concentration, oxygenated hemoglobin (HbO(2)) concentration, and oxidized cytochrome aa3 concentration were assessed in the calf using noninvasive near-infrared spectroscopy. Skin red blood cell flux close to the strain gauge was evaluated by laser Doppler fluxmetry. Results: P-i at control was -0.89 +/- 0.8 mm Hg and during elevation of venous pressure remained constant until a cuff pressure of 30 mm Hg was reached. It rose thereafter to 1.57 +/- 1.3 mm Hg (mean +/- SD). Skin red cell flux was significantly reduced when cuff pressure exceeded 30 mm Hg and, following cuff deflation, evidence of reactive hyperemia was obtained. Hb concentration increased significantly as a result of venous pressure elevation. No change in either HbO(2) or cytochrome aa3 concentration was observed as long as cuff pressure remained under diastolic blood pressure. Conclusions: The small increase in P-i together with an absence of impaired tissue oxygenation during the venous congestion plethysmography protocol described by Gamble et al. supports the contention thar this protocol enables accurate assessment of filtration capacity.