Báo cáo y học: How to evaluate the microcirculation: report of a round table conference

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Báo cáo y học: "How to evaluate the microcirculation: report of a round table conference" Available online http://ccforum.com/content/11/5/R101Research Open AccessVol 11 No 5How to evaluate the microcirculation: report of a round tableconferenceDaniel De Backer1, Steven Hollenberg2, Christiaan Boerma3,4, Peter Goedhart4,Gustavo Büchele1, Gustavo Ospina-Tascon1, Iwan Dobbe4 and Can Ince41Department of Intensive Care, Erasme University hospital, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070 Brussels, Belgium2Sections of Cardiology and Critical Care Medicine, Cooper University Hospital, One Cooper Plazza, Camden 08103, New Jersey, USA3Intensive Care Unit, Medical Centre Leeuwarden, P.O. box 888, 8901 BR Leeuwarden, The Netherlands4Department of Clinical Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The NetherlandsCorresponding author: Daniel De Backer, ddebacke@ulb.ac.beReceived: 9 May 2007 Revisions requested: 3 Jul 2007 Revisions received: 6 Aug 2007 Accepted: 10 Sep 2007 Published: 10 Sep 2007Critical Care 2007, 11:R101 (doi:10.1186/cc6118)This article is online at: http://ccforum.com/content/11/5/R101© 2007 De Backer et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction Microvascular alterations may play an important contrast adjustment, and recording quality. The scores that canrole in the development of organ failure in critically ill patients be used to describe numerically the microcirculatory imagesand especially in sepsis. Recent advances in technology have consist of the following: a measure of vessel density (total andallowed visualization of the microcirculation, but several scoring perfused vessel density; two indices of perfusion of the vesselssystems have been used so it is sometimes difficult to compare (proportion of perfused vessels and microcirculatory flow index);studies. This paper reports the results of a round table and a heterogeneity index. In addition, this information should beconference that was organized in Amsterdam in November provided for all vessels and for small vessels (mostly capillaries) identified as smaller than 20 μm. Venular perfusion should be2006 in order to achieve consensus on image acquisition andanalysis. reported as a quality control index, because venules should always be perfused in the absence of pressure artifact. It isMethods The participants convened to discuss the various anticipated that although this information is currently obtainedaspects of image acquisition and the different scores, and a manually, it is likely that image analysis software will easeconsensus statement was drafted using the Delphi analysis in the future.methodology.Results The participants identified the following five key points Conclusion We proposed that scoring of the microcirculationfor optimal image acquisition: five sites per organ, avoidance of should include an index of vascular density, assessment ofpressure artifacts, elimination of secretions, adequate focus and capillary perfusion and a heterogeneity index.Introduction Recent years have witnessed the introduction into clinicalThe microcirculation is a commonly neglected entity. Haemo- practice of devices that allow the microcirculation to be visual-dynamic assessment has long been limited to measurements ized directly. The orthogonal polarization spectral (OPS) [1]of cardiac output and oxygen delivery, even though microvas- and the sidestream dark field (SDF) [2] imaging devices bothcular oxygen delivery cannot be predicted from global haemo- provide high contrast images of the microvasculature. Bothdynamic measurements. Because the microcirculation is the devices are based on the principle that green light illuminatesprimary site of oxygen and nutrient exchange, therapeutic the depth of a tissue (up to 3 mm, according to the manufac-interventions aimed at increasing organ perfusion should be turer) and that the scattered green light is absorbed by haemo-accompanied by improved microvascular perfusion. globin of red blood cells contained in superficial vessels.FCD = functional capillary density; MFI = microcirculatory flow index; NTSC = National Television Systems Committee; OPS = orthogonal polarizationspectral; PAL = phase alternating line; PPV = proportion of perfused vessels; PVD = perfused vessel density; SDF = sidestream dark field; SECAM= sequential colour with memory. Page 1 of 9 (page number not for citation purposes)Critical Care Vol 11 No 5 De Backer et al.Accordingly, both devices ...