Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients
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We aimed to assess the impact of image quality on microcirculatory evaluation with sidestream dark-field (SDF) videomicroscopy in critically ill patients and explore factors associated with low video quality. This was a retrospective analysis of a single-centre prospective observational study. Videos of the sublingual microcirculation were recorded using SDF videomicroscopy in 100 adult patients within 12 h from admittance to the intensive care unit and every 24 h until discharge/death. Parameters of vessel density and perfusion were calculated offline for small vessels. For all videos, a quality score (−12 = unacceptable, 1 = suboptimal, 2 = optimal) was assigned for brightness, focus, content, stability, pressure and duration. Videos with a total score ≤8 were deemed as unacceptable. A total of 2455 videos (853 triplets) was analysed. Quality was acceptable in 56 % of videos. Lower quality was associated with worse microvascular density and perfusion. Unreliable triplets (≥1 unacceptable or missing video, 65 % of total) showed lower vessel density, worse perfusion and higher flow heterogeneity as compared to reliable triplets (p < 0.001). Quality was higher among triplets collected by an extensively-experienced investigator or in patients receiving sedation or mechanical ventilation. Perfused vessel density was higher in patients with Glasgow Coma Scale (GCS) ≤8 (18.9 ± 4.5 vs. 17.0 ± 3.9 mm/mm2 in those with GCS >8, p < 0.001) or requiring mechanical ventilation (18.0 ± 4.5 vs. 17.2 ± 3.8 mm/mm2 in not mechanically ventilated patients, p = 0.059). We concluded that SDF video quality depends on both the operator’s experience and patient’s cooperation. Low-quality videos may produce spurious data, leading to an overestimation of microvascular alterations.
KeywordsMicrocirculation Sidestream dark field imaging Microcirculatory image quality Critically ill patients
The authors wish to thank all those who participated in the data collection and analysis, and the medical and nurse staff of the Intensive Care Unit of Azienda Ospedaliera Universitaria “Ospedali Riuniti” of Ancona (Italy) for their support in the realisation of this work. No external funding was received for the realisation of this work.
Compliance with ethical standards
Conflict of interest
CI is the inventor of sidestream dark field imaging technology and holds shares in MicroVision Medical and was a consultant for this company more than 4 years ago but has had no further contact with the company since then. He has no other competing interests in this field and there are no other relationships or activities that could appear to have influenced the submitted work. The other authors declare that they have no conflict of interest.
- 9.Dubin A, Pozo MO, Casabella CA, Pálizas F Jr, Murias G, Moseinco MC, Kanoore Edul VS, Pálizas F, Estenssoro E, Ince C. Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care. 2009;13:R92.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Massey MJ, LaRochelle E, Najarro G, Karmacharla A, Arnold R, Trzeciak S, Angus DC, Shapiro NI. The microcirculation image quality score: development and preliminary evaluation of a proposed approach to grading quality of image acquisition for bedside videomicroscopy. J Crit Care. 2013;28:913–7.CrossRefPubMedGoogle Scholar
- 13.Donati A, Damiani E, Luchetti M, Domizi R, Scorcella C, Carsetti A, Gabbanelli V, Carletti P, Bencivenga R, Vink H, Adrario E, Piagnerelli M, Gabrielli A, Pelaia P, Ince C. Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study. Crit Care. 2014;18:R33.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Morelli A, Donati A, Ertmer C, Rehberg S, Lange M, Orecchioni A, Cecchini V, Landoni G, Pelaia P, Pietropaoli P, Van Aken H, Teboul JL, Ince C, Westphal M. Levosimendan for resuscitating the microcirculation in patients with septic shock: a randomized controlled study. Crit Care. 2010;14:R232.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Damiani E, Adrario E, Luchetti MM, Scorcella C, Carsetti A, Mininno N, Pierantozzi S, Principi T, Strovegli D, Bencivenga R, Gabrielli A, Romano R, Pelaia P, Ince C, Donati A. Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis. PLoS ONE. 2015;10:e0122655.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Gilbert-Kawai E, Coppel J, Bountziouka V, Ince C, Martin D, For the Caudwell Xtreme Everest and Xtreme Everest 2 Research Group. A comparison of the quality of image acquisition between the incident dark field and sidestream dark field videomicroscopes. BMC Med Imaging. 2016;16:10.CrossRefPubMedPubMedCentralGoogle Scholar