Qualitative real-time analysis by nurses of sublingual microcirculation in intensive care unit: the MICRONURSE study

Tanaka, Sébastien; Harrois, Anatole; Nicolaï, Camille; Flores, M.; Hamada, Sophie; Vicaut, Éric; Duranteau, Jacques

doi:10.1186/s13054-015-1106-3

Cited by 55 publications

(30 citation statements)

References 22 publications

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“…In combination with a larger field of view (1.55 × 1.16 mm = about three times larger than the field of view of previous devices) of the new generation camera, it could be argued that this camera provides more accurate information concerning microcirculation alterations then previous-generation SDF camera. On the other hand, default Cytocam measurements take between 3- and 5-s recordings which have been found to be of sufficient length in a large number of recent studies [22, 39–42]. A recent review on microcirculation measurements by Massey and Shapiro [43] also recommended that lengths of between 3 and 5 s are sufficient.…”

Section: Discussionmentioning

confidence: 99%

Microcirculatory assessment of patients under VA-ECMO

et al. 2016

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BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective technique for providing emergency mechanical circulatory support for patients with cardiogenic shock. VA-ECMO enables a rapid restoration of global systemic organ perfusion, but it has not been found to always show a parallel improvement in the microcirculation. We hypothesized in this study that the response of the microcirculation to the initiation of VA-ECMO might identify patients with increased chances of intensive care unit (ICU) survival.MethodsTwenty-four patients were included in this study. Sublingual microcirculation measurements were performed using the CytoCam-IDF (incident dark field) imaging device. Microcirculatory measurements were performed at baseline, after VA-ECMO insertion (T1), 48–72 h after initiation of VA-ECMO (T2), 5–6 days after (T3), 9–10 days after (T4), and within 24 h of VA-ECMO removal.ResultsOf the 24 patients included in the study population, 15 survived and 9 died while on VA-ECMO. There was no significant difference between the systemic global hemodynamic variables at initiation of VA-ECMO between the survivors and non-survivors. There was, however, a significant difference in the microcirculatory parameters of both small and large vessels at all time points between the survivors and non-survivors. Perfused vessel density (PVD) at baseline (survivor versus non-survivor, 19.21 versus 13.78 mm/mm2, p = 0.001) was able to predict ICU survival on initiation of VA-ECMO; the area under the receiver operating characteristic curve (ROC) was 0.908 (95 % confidence interval 0.772–1.0).ConclusionPVD of the sublingual microcirculation at initiation of VA-ECMO can be used to predict ICU mortality in patients with cardiogenic shock.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1519-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Microcirculatory assessment of patients under VA-ECMO

et al. 2016

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“…Both physicians were experienced in these techniques and trained to recognize and avoid pressure and movement artifacts. The real-time assessment of microvascular flow index (MFI by "eyeballing") was used as a post hoc verification to ensure representative recordings of the microvasculature [31]. The different parameters assessed by the two methods are summarized in Additional file 1: Table S1.…”

Section: Study Population and Study Designmentioning

confidence: 99%

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

et al. 2019

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Background The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis. Methods This observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck™). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values. Results In septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002; PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated exceptionally well with paired PBR values obtained at the bedside (rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters correlated well with the markers of critical illness. Interestingly, no association was observed between the PBR values and established microcirculation parameters. Conclusion Our findings suggest that eGC damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis. Trial registration Retrospectively registered: Clinicaltrials.gov, NCT03960307 Electronic supplementary material The online version of this article (10.1186/s13054-019-2542-2) contains supplementary material, which is available to authorized users.

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“…Directly monitoring the microcirculation is a powerful diagnostic tool and may help to better understand the individual problems of patients and the effects of haemodynamic therapy in the critical care setting [8]. Based on the availability of microcirculatory monitoring at the bedside and accumulating evidence, treatment decisions may be made on the basis of microvascular parameters in the near future [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of an automatic analysis and a manual analysis of conjunctival microcirculation in a sheep model of haemorrhagic shock

Arnemann

Heßler

Kampmeier

et al. 2016

ICMx

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BackgroundLife-threatening diseases of critically ill patients are known to derange microcirculation. Automatic analysis of microcirculation would provide a bedside diagnostic tool for microcirculatory disorders and allow immediate therapeutic decisions based upon microcirculation analysis.MethodsAfter induction of general anaesthesia and instrumentation for haemodynamic monitoring, haemorrhagic shock was induced in ten female sheep by stepwise blood withdrawal of 3 × 10 mL per kilogram body weight. Before and after the induction of haemorrhagic shock, haemodynamic variables, samples for blood gas analysis, and videos of conjunctival microcirculation were obtained by incident dark field illumination microscopy. Microcirculatory videos were analysed (1) manually with AVA software version 3.2 by an experienced user and (2) automatically by AVA software version 4.2 for total vessel density (TVD), perfused vessel density (PVD) and proportion of perfused vessels (PPV). Correlation between the two analysis methods was examined by intraclass correlation coefficient and Bland-Altman analysis.ResultsThe induction of haemorrhagic shock decreased the mean arterial pressure (from 87 ± 11 to 40 ± 7 mmHg; p < 0.001); stroke volume index (from 38 ± 14 to 20 ± 5 ml·m−2; p = 0.001) and cardiac index (from 2.9 ± 0.9 to 1.8 ± 0.5 L·min−1·m−2; p < 0.001) and increased the heart rate (from 72 ± 9 to 87 ± 11 bpm; p < 0.001) and lactate concentration (from 0.9 ± 0.3 to 2.0 ± 0.6 mmol·L−1; p = 0.001). Manual analysis showed no change in TVD (17.8 ± 4.2 to 17.8 ± 3.8 mm*mm−2; p = 0.993), whereas PVD (from 15.6 ± 4.6 to 11.5 ± 6.5 mm*mm−2; p = 0.041) and PPV (from 85.9 ± 11.8 to 62.7 ± 29.6%; p = 0.017) decreased significantly. Automatic analysis was not able to identify these changes. Correlation analysis showed a poor correlation between the analysis methods and a wide spread of values in Bland-Altman analysis.ConclusionsAs characteristic changes in microcirculation during ovine haemorrhagic shock were not detected by automatic analysis and correlation between automatic and manual analyses (current gold standard) was poor, the use of the investigated software for automatic analysis of microcirculation cannot be recommended in its current version at least in the investigated model. Further improvements in automatic vessel detection are needed before its routine use.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0110-5) contains supplementary material, which is available to authorized users.

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Qualitative real-time analysis by nurses of sublingual microcirculation in intensive care unit: the MICRONURSE study

Cited by 55 publications

References 22 publications

Microcirculatory assessment of patients under VA-ECMO

Microcirculatory assessment of patients under VA-ECMO

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Comparison of an automatic analysis and a manual analysis of conjunctival microcirculation in a sheep model of haemorrhagic shock

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