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Point-of-care assessment of microvascular blood flow in critically ill patients

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Abstract

Objective

Sublingual microvascular videomicroscopy can assess tissue perfusion in critically ill patients; however, data analysis is currently limited to delayed off-line evaluation. We hypothesized that a real-time point-of-care (POC) determination of the microcirculatory flow index (MFI), an established metric for assessing microcirculatory perfusion, agrees well with the conventional off-line analysis.

Design

Prospective observational study.

Setting

Urban academic intensive care unit.

Participants

A heterogeneous population of critically ill patients.

Measurements and results

A single operator performed side stream darkfield videomicroscopy of the sublingual microcirculation and made a POC determination of MFI in real-time on a portable bedside monitor by assigning a score (0 = no flow to 3 = normal) to each quadrant of the image and averaging the four values. After image processing, de-identification and randomization, the same operator, blinded to the previous interpretation, repeated the MFI assessment by viewing an AVI-formatted image sequence on a 94 cm 1,080 pixel LCD monitor (reference standard). There were 205 paired measurements in 18 subjects. The POC and reference standard MFI had good agreement by Bland–Altman analysis [mean difference of −0.031, SD = 0.198 (95% CI, −0.43 to 0.37)]. The POC assessment was 94% sensitive and 92% specific for detecting impaired microvascular flow (defined a priori as an MFI < 2.5 based on previously published data).

Conclusions

A POC determination of MFI had good agreement with conventional off-line analysis, and was highly sensitive and specific for detecting impaired microvascular flow. This real-time technique may be useful in future clinical trials targeting impaired microcirculatory perfusion in critically ill patients.

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Acknowledgments

This study was supported in part by a Resident Research Grant from the Emergency Medicine Foundation to Dr. Arnold. Dr. Trzeciak’s effort to this project was supported by a grant from the National Institutes of Health/National Institutes of General Medical Sciences (K23GM83211).

Conflict of interest statement

None of the authors have financial conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, One Cooper Plaza, Camden, NJ, 08103, USA

    Ryan C. Arnold, Michael E. Chansky & Stephen Trzeciak

  2. Divisions of Cardiovascular Disease and Critical Care Medicine, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, Camden, NJ, USA

    Joseph E. Parrillo, R. Phillip Dellinger, Stephen Trzeciak & Steven M. Hollenberg

  3. Department of Surgery, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, Camden, NJ, USA

    David J. Lundy

  4. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Nathan I. Shapiro

Authors
  1. Ryan C. Arnold
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  2. Joseph E. Parrillo
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  3. R. Phillip Dellinger
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  4. Michael E. Chansky
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  5. Nathan I. Shapiro
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  6. David J. Lundy
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  7. Stephen Trzeciak
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  8. Steven M. Hollenberg
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Corresponding author

Correspondence to Ryan C. Arnold.

Additional information

On behalf of the Microcirculatory Alterations in Resuscitation and Shock (MARS) Investigators.

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Arnold, R.C., Parrillo, J.E., Phillip Dellinger, R. et al. Point-of-care assessment of microvascular blood flow in critically ill patients. Intensive Care Med 35, 1761–1766 (2009). https://doi.org/10.1007/s00134-009-1517-1

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  • DOI: https://doi.org/10.1007/s00134-009-1517-1

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