Sublingual microcirculation in prehospital critical care medicine: A proof‐of‐concept study

Bruno, Raphael Romano; Reed, Markus; Bimpong-Buta, Nana-Yaw; Muessig, Johanna M.; Masyuk, Maryna; Binneboessel, Stephan; Franz, Marcus; Kelm, Malte; Jung, Christian

doi:10.1111/micc.12614

Cited by 8 publications

(8 citation statements)

References 30 publications

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“…There is still controversy about the interpretation of the data from this study [35]. Another promising approach is the investigation of sublingual microcirculation using Sidestream Dark Field Imaging (SDF) [36]. In the early stages of shock, there is currently no clear benefit for SDF [37].…”

Section: Discussionmentioning

confidence: 97%

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

et al. 2020

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Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction.

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Section: Discussionmentioning

confidence: 97%

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

et al. 2020

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“…One possibility would be to directly assess the microcirculation to detect disturbed organ perfusion, which could detect organ function failure at an early stage, and to treat this earlier [31,32]. A commonly investigated method for direct microcirculation measurement is the use of hand-held-video microscopy, which is mainly used sublingually [33], and can be used for example even in the context of emergency medical situations [34]. In the context of the COVID-19 pandemic, the important role of microcirculation in this disease has been analyzed several times [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients

Bruno

Wernly²,

Hornemann

et al. 2021

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PURPOSE Critically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients. METHODS The Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality. RESULTS In total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268–1.949, p < 0.001), ICU-, and 3-month-mortality. CONCLUSION In critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.

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“…[56,57] Numerous studies have shown that alterations in the sublingual microcirculation can surpass alterations in systemic hemodynamic parameters in terms of their predictive accuracy. [58] In a severely infected porcine model, the OPS technique revealed major alterations in both sublingual and intestinal microcirculation. [59] The microcirculatory changes were correlated with the severity of the infection.…”

Section: Scorementioning

confidence: 99%

Research progress on microcirculatory disorders in septic shock: A narrative review

Wang,

Ding,

Wang

et al. 2024

Medicine

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Hemodynamic coherence plays a critical role in the outcomes of septic shock. Due to the potential negative consequences of microcirculatory disorders on organ failure and clinical outcomes, the maintenance of a balance between the macrocirculation and microcirculation is a topic of significant research focus. Although physical methods and specialized imaging techniques are used in clinical practice to assess microcirculation, the use of monitoring devices is not widespread. The integration of microcirculation research tools into clinical practice poses a significant challenge for the future. Consequently, this review aims to evaluate the impact of septic shock on the microcirculation, the methods used to monitor the microcirculation and highlight the importance of microcirculation in the treatment of critically ill patients. In addition, it proposes an evaluation framework that integrates microcirculation monitoring with macrocirculatory parameters. The optimal approach should encompass dynamic, multiparametric, individualized, and continuous monitoring of both the macrocirculation and microcirculation, particularly in cases of hemodynamic separation.

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Sublingual microcirculation in prehospital critical care medicine: A proof‐of‐concept study

Cited by 8 publications

References 30 publications

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients

Research progress on microcirculatory disorders in septic shock: A narrative review

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