Intensive Care Medicine

, Volume 44, Issue 3, pp 281–299 | Cite as

Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine

  • Can InceEmail author
  • E. Christiaan Boerma
  • Maurizio Cecconi
  • Daniel De Backer
  • Nathan I. Shapiro
  • Jacques Duranteau
  • Michael R. Pinsky
  • Antonio Artigas
  • Jean-Louis Teboul
  • Irwin K. M. Reiss
  • Cesar Aldecoa
  • Sam D. Hutchings
  • Abele Donati
  • Marco Maggiorini
  • Fabio S. Taccone
  • Glenn Hernandez
  • Didier Payen
  • Dick Tibboel
  • Daniel S. Martin
  • Alexander Zarbock
  • Xavier Monnet
  • Arnaldo Dubin
  • Jan Bakker
  • Jean-Louis Vincent
  • Thomas W. L. Scheeren
  • On behalf of the Cardiovascular Dynamics Section of the ESICM
Conference Reports and Expert Panel



Hand-held vital microscopes (HVMs) were introduced to observe sublingual microcirculatory alterations at the bedside in different shock states in critically ill patients. This consensus aims to provide clinicians with guidelines for practical use and interpretation of the sublingual microcirculation. Furthermore, it aims to promote the integration of routine application of HVM microcirculatory monitoring in conventional hemodynamic monitoring of systemic hemodynamic variables.


In accordance with the Delphi method we organized three international expert meetings to discuss the various aspects of the technology, physiology, measurements, and clinical utility of HVM sublingual microcirculatory monitoring to formulate this consensus document. A task force from the Cardiovascular Dynamics Section of the European Society of Intensive Care Medicine (with endorsement of its Executive Committee) created this consensus as an update of a previous consensus in 2007. We classified consensus statements as definitions, requirements, and/or recommendations, with a minimum requirement of 80% agreement of all participants.


In this consensus the nature of microcirculatory alterations is described. The nature of variables, which can be extracted from analysis of microcirculatory images, is presented and the needed dataset of variables to identify microcirculatory alterations is defined. Practical aspects of sublingual HVM measurements and the nature of artifacts are described. Eleven statements were formulated that pertained to image acquisitions and quality statements. Fourteen statements addressed the analysis of the images, and 13 statements are related to future developments.


This consensus describes 25 statements regarding the acquisition and interpretation of microcirculatory images needed to guide the assessment of the microcirculation in critically ill patients.


Hemodynamic monitoring Microcirculation Sepsis Shock Fluid therapy Sublingual Sepsis Intensive care OPS imaging SDF imaging IDF imaging 



Many have contributed with their expertise to the formation of this paper. The authors wish to specifically thank the following persons: Marly van Assen, Sam Arend, Sam Boerma, Vanina Edul, Hernanado Gomez, Matthias Hilty, Yasin Ince, Michael Massey, Gerke Veenstra, Claudia Scorcella, Sherezade Tovar-Doncel, and ZuhreUz.

Compliance with ethical standards

Conflicts of interest

C. Ince has developed SDF imaging and is listed as inventor on related patents commercialized by MicroVision Medical (MVM) under a license from the Academic Medical Center (AMC). He has been a consultant for MVM in the past but has not been involved with this company for more than 5 years now, and hold no shares. Braedius Medical, a company owned by a relative of Dr. Ince, has developed and designed a hand-held microscope called CytoCam-IDF imaging. Dr. Ince has no financial relation with Braedius Medical of any sort, i.e., he has never owned shares or received consultancy or speaker fees from Braedius Medical. He runs an Internet site which offers services (training, courses, and analysis) related to clinical microcirculation. The other authors have no declared interest with respect to this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Can Ince
    • 1
    • 2
    Email author
  • E. Christiaan Boerma
    • 3
  • Maurizio Cecconi
    • 4
  • Daniel De Backer
    • 5
  • Nathan I. Shapiro
    • 6
  • Jacques Duranteau
    • 7
  • Michael R. Pinsky
    • 8
  • Antonio Artigas
    • 9
  • Jean-Louis Teboul
    • 10
  • Irwin K. M. Reiss
    • 11
  • Cesar Aldecoa
    • 12
  • Sam D. Hutchings
    • 13
  • Abele Donati
    • 14
  • Marco Maggiorini
    • 15
  • Fabio S. Taccone
    • 16
  • Glenn Hernandez
    • 17
  • Didier Payen
    • 18
  • Dick Tibboel
    • 19
  • Daniel S. Martin
    • 20
    • 21
  • Alexander Zarbock
    • 22
  • Xavier Monnet
    • 10
  • Arnaldo Dubin
    • 23
  • Jan Bakker
    • 1
    • 17
    • 24
  • Jean-Louis Vincent
    • 16
  • Thomas W. L. Scheeren
    • 25
  • On behalf of the Cardiovascular Dynamics Section of the ESICM
  1. 1.Department of Intensive CareErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
  2. 2.Department of Translational PhysiologyAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Intensive CareMedical Centre LeeuwardenLeeuwardenThe Netherlands
  4. 4.Anaesthesia and Intensive CareSt George’s Hospital and Medical SchoolLondonUK
  5. 5.Department of Intensive Care, CHIREC HospitalsUniversité Libre de BruxellesBrusselsBelgium
  6. 6.Department of Emergency Medicine and Center for Vascular Biology ResearchBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  7. 7.Anesthesia and Intensive Care DepartmentHôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital De Bicêtre, Assistance Publique Hôpitaux de ParisLe Kremlin-BicêtreFrance
  8. 8.Department of Critical Care MedicineUniversity of PittsburghPittsburghUSA
  9. 9.Critical Care Center, Hospital de Sabadell, CIBER Enfermedades RespiratoriasUniversidad Autónoma de BarcelonaSabadellSpain
  10. 10.Service de Réanimation Médicale Hôpital de BicêtreHôpitaux Universitaires Paris-Sud, AP-HPLe Kremlin-BicêtreFrance
  11. 11.Department of Pediatrics, Division of NeonatologyErasmus MC-Sophia Children’s Hospital, Erasmus Medical CenterRotterdamThe Netherlands
  12. 12.Department of Anesthesiology and Surgical Critical CareHospital Universitario Rio HortegaValladolidSpain
  13. 13.Kings College HospitalLondonUK
  14. 14.Anesthesia and Intensive Care UnitUniversità Politecnica delle MarcheAnconaItaly
  15. 15.Medical Intensive Care UnitUniversity Hospital of ZurichZurichSwitzerland
  16. 16.Department of Intensive CareHôpital ErasmeBrusselsBelgium
  17. 17.Departamento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  18. 18.Department of Anesthesiology and Critical Care, Lariboisière HospitalUniversity of Paris Denis Diderot 7ParisFrance
  19. 19.Intensive Care and Department of Pediatric Surgery, Erasmus Medical CenterSophia Children’s HospitalRotterdamThe Netherlands
  20. 20.Intensive Care UnitUniversity College LondonLondonUK
  21. 21.Division of Surgery and Interventional ScienceRoyal Free HospitalLondonUK
  22. 22.Department of Anaesthesiology, Intensive Care Medicine and Pain MedicineUniversity Hospital MünsterMunsterGermany
  23. 23.Servicio de Terapia IntensivaSanatorio Otamendi y MiroliBuenos AiresArgentina
  24. 24.Department of Pulmonology and Critical Care MedicineColumbia University Medical CenterNew YorkUSA
  25. 25.Department of Anesthesiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

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