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

Abstract

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.

Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

“…The heterogeneity of perfusion is low in healthy individuals, however, the microcirculation has become a particular focus in pathophysiological conditions over the last decades as endothelial dysfunction at the organ level has been linked to sepsis and microcirculatory alterations have been observed to be more prominent in non-survivors than in survivors [28]. Therefore, hand-held microscopes (HVMs) have been developed and recently introduced into the clinic to assess the microcirculation and the second consensus paper on how to perform this was recently published [29]. The latest generation of HVM devices is based on incident dark-field (IDF) imaging and has improved optical lenses and high-resolution computer-controlled image sensors compared to the previous generation that is based on side-stream dark field (SDF) imaging.…”

Could resuscitation be based on microcirculation data? No

“…In the field of microcirculation imaging, the most recent update [14] does not recommend routine clinical use for resuscitation since there is lack of consensus on how this might be achieved, and the definition on the reference values for microcirculation-guided resuscitation end points are not yet established. Furthermore, in their recent consensus on haemodynamic monitoring and circulatory shock, the Task Force of the European Society of Intensive Care Medicine has recommended that techniques to monitor the microcirculation be used for research purposes only (Recommendation 20) [15].…”

A new complimentary web‐based tool for manual analysis of microcirculation videos: Validation of the Capillary Mapper against the current gold standard AVA 3.2

“…Disturbances of the microcirculation are of crucial relevance in the development of organ dysfunction and are associated with increased mortality . Whereas former technologies required the application of a dye to visualize the microcirculation for a limited time period, newly developed computer‐controlled image sensor‐based HVM can visualize the microcirculation directly and continuously, and are therefore finding widespread use in experimental and clinical research . In 2007 a consensus conference made the first recommendations for the analysis of microcirculation videos .…”

“…In 2007 a consensus conference made the first recommendations for the analysis of microcirculation videos . A second consensus on the assessment of sublingual microcirculation in critically ill patients was published recently . However, the analysis of microcirculatory videos is still dependent on the individual investigator, because available programs allow only manual or semi‐manual analyses.…”

“…The Capillary Mapper 1.3 (http://capillary-mapper.uni-muenster.de/), a web‐based freely accessible software program for the manual analysis of the microcirculation, was developed to meet this demand. The aim of the current study was to compare the Capillary Mapper 1.3 with the AVA 3.2 software, which is currently the gold standard for manual analysis of microcirculation videos according to the latest recommendations of the consensus conference …”