Monitoring the sublingual microcirculation using sidestream dark field imaging during fluid resuscitation in patients with septic shock

Blanken, F. van (2015) Monitoring the sublingual microcirculation using sidestream dark field imaging during fluid resuscitation in patients with septic shock. thesis, Medicine.

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Abstract

OBJECTIVES: To explore sublingual microcirculatory alterations before and during fluid resuscitation in patients with septic shock. The primary aim is to determine whether there is a difference in microcirculation in patients following a stroke volume variation (SVV) and extravascular lung water (EVLW) guided resuscitation strategy, as compared to a central venous pressure (CVP) guided resuscitation strategy. The secondary aim is to evaluate the reproducibility of the microcirculatory flow index (MFI) and the tertiary aim is to compare automated and semiquantitative analysis. DESIGN: Prospective observational pilot study, as substudy of a trial comparing two different fluid strategies in an eighteen-bed medical- surgical level 3 Intensive Care Unit. METHODS: A total of 8 patients with septic shock were included. Resuscitation was guided by either SVV and EVLW or CVP. Using sidestream dark-field imaging, sublingual microcirculation was visualized at baseline and after 6, 24 and 48 hours. After imaging MFI was determined visually, and automated and semiquantitative analysis for total vessel density (TVD), perfused vessel density (PVD) and proportion of perfused vessels (PPV) was performed. RESULTS: MFI showed an increasing trend in the first 48 hours following resuscitation in a similar fashion for both resuscitation strategies. Scoring the MFI in a sample of 111 videos showed high correlations for all vessels (0.76) and small vessels (0.74) between two researchers, with excellent an correlation for small vessels when classifying the MFI as good or bad (0.82). For a sample of 23 videos, automated and semiquantitative analysis showed poor correlations for TVD (0.17), PVD (0.19) and PPV (0.30). CONCLUSIONS: MFI seems to improve during both strategies of fluid resuscitation. Reproducibility of scoring MFI is high between two trained researchers, whereas further technical improvements must be made before automated analysis of other microcirculatory parameters can be implemented into daily clinical practice.

Item Type:	Thesis (Thesis)
Supervisor name:	Beishuizen, Dr A. Intensivist Internist and Ozdemir, Drs A. Intensivist Anaesthesist and Intensive care unit and Medisch Spectrum Twente and Enschede
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2228

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