Nivin Sharawy1,2,3, Ahmed Mukhtar1, Sufia Islam3, Reham Mahrous1, Hassan Mohamed1, Mohamed Ali1, Amr A Hakeem1, Osama Hossny1, Amera Refaa1, Ahmed Saka1, Vladimir Cerny3, Sara Whynot3, Ronald B George3, Christian Lehmann3,4,5. 1. Surgical Intensive Care Trauma Center, Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt. 2. Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt. 3. Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 4. Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada. 5. Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.
Abstract
INTRODUCTION: The outcome of patients in septic shock has been shown to be related to changes within the microcirculation. Modern imaging technologies are available to generate high resolution video recordings of the microcirculation in humans. However, evaluation of the microcirculation is not yet implemented in the routine clinical monitoring of critically ill patients. This is mainly due to large amount of time and user interaction required by the current video analysis software. The aim of this study was to validate a newly developed automated method (CCTools®) for microcirculatory analysis of sublingual capillary perfusion in septic patients in comparison to standard semi-automated software (AVA3®). METHODS: 204 videos from 47 patients were recorded using incident dark field (IDF) imaging. Total vessel density (TVD), proportion of perfused vessels (PPV), perfused vessel density (PVD), microvascular flow index (MFI) and heterogeneity index (HI) were measured using AVA3® and CCTools®. RESULTS: Significant differences between the numeric results obtained by the two different software packages were observed. The values for TVD, PVD and MFI were statistically related though. CONCLUSION: The automated software technique successes to show septic shock induced microcirculation alterations in near real time. However, we found wide degrees of agreement between AVA3® and CCTools® values due to several technical factors that should be considered in the future studies.
INTRODUCTION: The outcome of patients in septic shock has been shown to be related to changes within the microcirculation. Modern imaging technologies are available to generate high resolution video recordings of the microcirculation in humans. However, evaluation of the microcirculation is not yet implemented in the routine clinical monitoring of critically illpatients. This is mainly due to large amount of time and user interaction required by the current video analysis software. The aim of this study was to validate a newly developed automated method (CCTools®) for microcirculatory analysis of sublingual capillary perfusion in septicpatients in comparison to standard semi-automated software (AVA3®). METHODS: 204 videos from 47 patients were recorded using incident dark field (IDF) imaging. Total vessel density (TVD), proportion of perfused vessels (PPV), perfused vessel density (PVD), microvascular flow index (MFI) and heterogeneity index (HI) were measured using AVA3® and CCTools®. RESULTS: Significant differences between the numeric results obtained by the two different software packages were observed. The values for TVD, PVD and MFI were statistically related though. CONCLUSION: The automated software technique successes to show septic shock induced microcirculation alterations in near real time. However, we found wide degrees of agreement between AVA3® and CCTools® values due to several technical factors that should be considered in the future studies.
Entities:
Keywords:
Sublingual microcirculation; capillary perfusion; incident dark field imaging; sepsis; shock
Authors: Christian S Guay; Mariam Khebir; T Shiva Shahiri; Ariana Szilagyi; Erin Elizabeth Cole; Gabrielle Simoneau; Mohamed Badawy Journal: Intensive Care Med Exp Date: 2021-04-02