De Backer Daniel, Hollenberg Steven, Boerma Christiaan, Goedhart Peter, Büchele Gustavo, Ospina-Tascon Gustavo, Dobbe Iwan, Ince Can
Department of Intensive Care, Erasme University hospital, Université Libre de Bruxelles, 808 route de Lennik, B-1070 Brussels, Belgium.
Crit Care. 2007;11(5):R101. doi: 10.1186/cc6118.
Microvascular alterations may play an important role in the development of organ failure in critically ill patients and especially in sepsis. Recent advances in technology have allowed visualization of the microcirculation, but several scoring systems have been used so it is sometimes difficult to compare studies. This paper reports the results of a round table conference that was organized in Amsterdam in November 2006 in order to achieve consensus on image acquisition and analysis.
The participants convened to discuss the various aspects of image acquisition and the different scores, and a consensus statement was drafted using the Delphi methodology.
The participants identified the following five key points for optimal image acquisition: five sites per organ, avoidance of pressure artifacts, elimination of secretions, adequate focus and contrast adjustment, and recording quality. The scores that can be used to describe numerically the microcirculatory images consist of the following: a measure of vessel density (total and perfused vessel density; two indices of perfusion of the vessels (proportion of perfused vessels and microcirculatory flow index); and a heterogeneity index. In addition, this information should be provided for all vessels and for small vessels (mostly capillaries) identified as smaller than 20 microm. Venular perfusion should be reported as a quality control index, because venules should always be perfused in the absence of pressure artifact. It is anticipated that although this information is currently obtained manually, it is likely that image analysis software will ease analysis in the future.
We proposed that scoring of the microcirculation should include an index of vascular density, assessment of capillary perfusion and a heterogeneity index.
微血管改变可能在危重症患者尤其是脓毒症患者的器官功能衰竭发展过程中起重要作用。技术的最新进展已使微循环可视化，但已使用了多种评分系统，因此有时难以比较各项研究。本文报告了2006年11月在阿姆斯特丹组织的一次圆桌会议的结果，目的是就图像采集和分析达成共识。
与会者聚集在一起讨论图像采集的各个方面和不同的评分，并用德尔菲法起草了一份共识声明。
与会者确定了优化图像采集的以下五个关键点：每个器官五个部位、避免压力伪影、清除分泌物、适当聚焦和对比度调整以及记录质量。可用于以数字方式描述微循环图像的评分包括：血管密度测量值（总血管密度和灌注血管密度）；血管灌注的两个指标（灌注血管比例和微循环血流指数）；以及一个异质性指数。此外，应提供所有血管以及识别出的直径小于20微米的小血管（主要是毛细血管）的此信息。静脉灌注应作为质量控制指标报告，因为在无压力伪影的情况下静脉应始终处于灌注状态。预计尽管目前此信息是手动获取的，但未来图像分析软件可能会简化分析。
我们提议微循环评分应包括血管密度指数、毛细血管灌注评估和异质性指数。
