Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study

E Christiaan Boerma, Keshen R Mathura, Peter H J van der Voort, Peter E Spronk, Can Ince, E Christiaan Boerma, Keshen R Mathura, Peter H J van der Voort, Peter E Spronk, Can Ince

Abstract

Introduction: The introduction of orthogonal polarization spectral (OPS) imaging in clinical research has elucidated new perspectives on the role of microcirculatory flow abnormalities in the pathogenesis of sepsis. Essential to the process of understanding and reproducing these abnormalities is the method of quantification of flow scores.

Methods: In a consensus meeting with collaboraters from six research centres in different fields of experience with microcirculatory OPS imaging, premeditated qualifications for a simple, translucent and reproducible way of flow scoring were defined. Consecutively, a single-centre prospective observational validation study was performed in a group of 12 patients with an abdominal sepsis and a new stoma. Flow images of the microcirculation in vascular beds of the sublingual and stoma region were obtained, processed and analysed in a standardised way. We validated intra-observer and inter-observer reproducibility with kappa cross-tables for both types of microvascular beds.

Results: Agreement and kappa coefficients were >85% and >0.75, respectively, for interrater and intrarater variability in quantification of flow abnormalities during sepsis, in different subsets of microvascular architecture.

Conclusion: Semi-quantitative analysis of microcirculatory flow, as described, provides a reproducible and transparent tool in clinical research to monitor and evaluate the microcirculation during sepsis.

Figures

Figure 1
Figure 1
Orthogonal polarization imaging of a microvascular network; the sublingual microvascular architecture. The image is divided in four quadrants (a, b, c and d) with examples of vessel classification: small (s; 10 to 25 μm); medium (m; 26 to 50 μm); large (l; 51 to 100 μm). Objective 5×, on screen 325×.
Figure 2
Figure 2
Orthogonal polarization imaging of a repeating vascular structure; the villi of the small intestine. Objective 5×, on screen 325×.

References

    1. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32:1825–1831.
    1. Ince C. Microcirculation in distress: a new resuscitation end point. Crit Care Med. 2004;32:1963–1964.
    1. Slaaf DW, Tangelder GJ, Reneman RS. A versatile incident illuminator for intravital microscopy. Int J Microcirc Clin Exp. 1987;6:391–397.
    1. Mathura KR, Alić L, Ince C. Initial clinical experience with OPS imaging for observation of the human microcirculation. In: Vincent JL, editor. Yearbook of Intensive Care and Emergency Medicine. New York: Springer-Verlag; 2001. pp. 233–245.
    1. Mathura KR, Bouma GJ, Ince C. Abnormal microcirculation in brain tumours during surgery. Lancet. 2001;358:1698–1699.
    1. Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF. Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet. 2002;360:1395–1396.
    1. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98–104.
    1. De Backer, Creteur J, Vincent JL. Use of orthogonal polarization spectral imaging in intensive care. Orthogonal polarization spectral imaging Prog Appl Microcirc. 2000;24:104–109.
    1. Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG. Orthogonal polarization spectral imaging: A new method for study of the microcirculation. Nat Med. 1999;5:1209–1212.
    1. Harris AG, Sinitsina I, Messmer K. The cytoscanTM model E-II, a new reflectance microscope for intravital microscopy: comparison with the standard fluorescence method. J Vasc Res. 2000;37:469–476.
    1. Ince C, Ashruf JF, Avontuur JA, Wieringa PA, Spaan JA, Bruining HA. Heterogeneity of the hypoxic state in rat heart is determined at the capillary level. Am J Physiol. 1993;264:H294–H301.
    1. Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;228:303–308.
    1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
    1. Cohen J. Weighted kappa: nominal scale agreement with provision for scale disagreement or partial credit. Psychol Bull. 1968;70:213–220.
    1. Weil MH, Nakagawa Y, Tang W. Sublingual capnometry: a new non-invasive measurement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med. 1999;27:1225–1229.
    1. Marik PE. Sublingual capnography: a clinical validation study. Chest. 2001;120:923–927.
    1. Schwarte LA, Fournell A, van Bommel J, Ince C. Redistribution of intestinal microcirculatory oxygenation during acute hemodilution in pigs. J Appl Physiol. 2005;98:1070–1075.
    1. Buise MP, Ince C, Tilanus HW, Gommers D, van Bommel J. The effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction. Anesth Analg. 2005;100:1107–1111.
    1. Boerma EC, van der Voort PHJ, Ince C. Sublingual microcirculatory flow is impaired by the vasopressin-analogue terlipressin in a patient with catecholamine-resistant septic shock. Acta Anaesthesiol Scand. 2005;49:1387–1390.
    1. Gutierrez G. The rate of oxygen release and its effect on capillary O2 tension: a mathematical analysis. Respir Physiol. 1986;63:79–96.
    1. Ince C. The microcirculation is the motor of sepsis. Critical Care. 2005;9(suppl 4):S13–S19.
    1. Lindeboom JAH, Mathura KR. Microvascular changes in alveolar distraction osteogenesis. J Vasc Res. 2004;41(suppl 2):3.1.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren