Clinical Hemorheology and Microcirculation - Volume 67, issue 3-4

Article Type: Other

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 485-485, 2017

Authors: Lehmann, Christian

Article Type: Editorial

DOI: 10.3233/CH-179231

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 487-488, 2017

Authors: Sharawy, Nivin | Mukhtar, Ahmed | Islam, Sufia | Mahrous, Reham | Mohamed, Hassan | Ali, Mohamed | Hakeem, Amr A. | Hossny, Osama | Refaa, Amera | Saka, Ahmed | Cerny, Vladimir | Whynot, Sara | George, Ronald B. | Lehmann, Christian

Article Type: Research Article

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. Show more

Keywords: Sublingual microcirculation, sepsis, shock, capillary perfusion, incident dark field imaging

DOI: 10.3233/CH-179232

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 489-498, 2017

Authors: Cerny, Vladimir | Astapenko, David | Burkovskiy, Ian | Hyspler, Radomir | Ticha, Alena | Trevors, Mary Ann | Lehmann, Christian

Article Type: Research Article

Abstract: The endothelial glycocalyx (EG) lining the endoluminal surface of the capillaries has been proposed as a key component of the microcirculation and a major player in microvascular pathology. Recent advances in the understanding of its physiological role and clinical significance have been made upon the development of methods allowing EG assessment in clinical medicine. Laboratory methods can assess the amount of EG damage by measuring levels of its degradation products (e.g. syndecan-1, heparan sulphate and hyaluronan sulphate), mostly in the plasma, however, their physiological turnover disqualifies them from being the reliable index of EG damage. At the bedside, in vivo video …microscopy tools technologies (e.g. Side-stream Dark Field imaging technology) allow indirect assessment of EG thickness in sublingual microcirculation by measuring the penetration extent (called Perfused Boundary Region) of flowing red blood cells into the EG. Show more

Keywords: Endothelial glycocalyx, laboratory methods, videomicroscopy, Perfused Boundary Region

DOI: 10.3233/CH-179235

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 499-503, 2017

Authors: Henzler, Dietrich | Scheffler, Matthias | Westheider, Arne | Köhler, Thomas

Article Type: Research Article

Abstract: BACKGROUND: In patients with shock, inflammation and sepsis alterations in microcirculation are common problems. Although the pathophysiologic consequences are well understood, measurements of microcirculation have not entered clinical routine so far. OBJECTIVE: To characterize the requirements for clinical microcirculation measurement techniques and the barriers for implementation into routine practice. METHODS: Clinical review of reliability, reproducibility, validity, availability and usefulness of clinically available measurement techniques to be used in patients with sepsis or cardiac surgery with cardiopulmonary bypass. RESULTS: Few methods such as video microscopy are readily available at the bedside, but are hampered by …the high variability of measurements and the lack of reliable automated software analysis. The correlation of microcirculation impairment measured by in-vivo microscopy with fatal outcomes has been established, but no recommendations have been given which parameters should be targeted to improve outcomes. Measurement of regional brain tissue oxygenation has been recommended for cardiac surgery, but does not specifically target microcirculation. CONCLUSIONS: International guidelines for the management of sepsis or cardiac anesthesia do not recommend specific goals targeting the microcirculation directly, but global hemodynamics. The reason for this may be attributed to the lack of methods that fulfill the requirements necessary to be clinically acceptable. Once the validity, i.e. any improvement in patient’s outcomes attributable to microcirculation measurements, can be established, clinical measurement of microcirculation could become part of routine treatment of patients with sepsis, inflammation and shock. Until then, more clinical studies targeting microcirculation are urgently needed. Show more

Keywords: Sepsis, shock, microcirculation, technology, in-vivo microscopy, cardiac anesthesia, inflammation

DOI: 10.3233/CH-179229

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 505-509, 2017

Authors: Kern, Hartmut | Sharawy, Nivin | Sardinha, Joel | Lehmann, Christian

Article Type: Research Article

Abstract: Community hospitals provide ideal conditions for large clinical studies because of the high volume of unselected patients admitted every year. With regard to microcirculatory studies, there are still some feasibility problems which are not solved yet. First of all, the lack of reliable automated software to analyze microcirculatory images represents the most important issue. Secondly, hardware aspects still need improvements regarding portability and miniaturization. Finally, to conduct studies of the microcirculation in a community hospital is also always a funding issue. The cost of the measurement device is hereby only one factor. Main cost factor is the personnel.

DOI: 10.3233/CH-179233

Citation: Clinical Hemorheology and Microcirculation, vol. 67, no. 3-4, pp. 511-514, 2017