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Intensive Care Med. 2009 Oct;35(10):1761-6. doi: 10.1007/s00134-009-1517-1. Epub 2009 Jun 24.

Point-of-care assessment of microvascular blood flow in critically ill patients.

Author information

1
Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA. arnold-ryan@cooperhealth.edu

Abstract

OBJECTIVE:

Sublingual microvascular videomicroscopy can assess tissue perfusion in critically ill patients; however, data analysis is currently limited to delayed off-line evaluation. We hypothesized that a real-time point-of-care (POC) determination of the microcirculatory flow index (MFI), an established metric for assessing microcirculatory perfusion, agrees well with the conventional off-line analysis.

DESIGN:

Prospective observational study.

SETTING:

Urban academic intensive care unit.

PARTICIPANTS:

A heterogeneous population of critically ill patients.

MEASUREMENTS AND RESULTS:

A single operator performed side stream darkfield videomicroscopy of the sublingual microcirculation and made a POC determination of MFI in real-time on a portable bedside monitor by assigning a score (0 = no flow to 3 = normal) to each quadrant of the image and averaging the four values. After image processing, de-identification and randomization, the same operator, blinded to the previous interpretation, repeated the MFI assessment by viewing an AVI-formatted image sequence on a 94 cm 1,080 pixel LCD monitor (reference standard). There were 205 paired measurements in 18 subjects. The POC and reference standard MFI had good agreement by Bland-Altman analysis [mean difference of -0.031, SD = 0.198 (95% CI, -0.43 to 0.37)]. The POC assessment was 94% sensitive and 92% specific for detecting impaired microvascular flow (defined a priori as an MFI < 2.5 based on previously published data).

CONCLUSIONS:

A POC determination of MFI had good agreement with conventional off-line analysis, and was highly sensitive and specific for detecting impaired microvascular flow. This real-time technique may be useful in future clinical trials targeting impaired microcirculatory perfusion in critically ill patients.

PMID:
19554307
DOI:
10.1007/s00134-009-1517-1
[Indexed for MEDLINE]

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