Lehmann Ch, Abdo I, Kern H, Maddison L, Pavlovic D, Sharawi N, Starkopf J, Hall R, Johnson P, Williams L, Cerny V
Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic.
Clin Hemorheol Microcirc. 2014;57(2):137-46. doi: 10.3233/CH-141810.
In clinical setting, Sidestream Dark Field (SDF) imaging has provided unprecedented insights into the gut microcirculation mainly by studying the intestinal mucosa of patients with ileostomies. Visualizing microvascular structure and function of ileal mucosa at the bedside brings unique opportunity for clinical research, particularly in critically ill patients. Several papers that were focused on intestinal microcirculation, used different methods of assessment because an accepted scoring systems does not exist so far and it is no surprise that it is rather difficult to compare the results from these studies. The present paper presents recommendations concerning specific aspects of image acquisition and proposes some parameters for the description of the intestinal microcirculation in human studies, as suggested by the participants of a round table meeting.
The round table meeting participants reviewed all relevant literature, discussed various aspects of image acquisition by SDF technology in patients with ileostomy and parameters for the description of intestinal mucosa microcirculation. Selected key conditions for high quality and reproducible image recordings were identified. To evaluate quality of intestinal microcirculation, selected parameters and scoring system were suggested and described.
For image acquisition in ileostomies, five key points were proposed: optimal timing, optimal SDF device probe positioning, optimal stabilization, optimal number and length of acquired video recordings, and optimal avoidance of pressure artefacts. With regard to image analysis, simplified set of quantitative and qualitative parameters for the description of the intestinal mucosa microcirculation for the clinical studies has been proposed: vessels per villus, microvascular flow index, proportion of perfused villi, and borders of villi. The proposed parameters can be included in a semi-quantitative scoring system; however, this scoring system needs further validation. This simplified analysis does not require sophisticated software and can be performed manually on the video screen.
We propose a simple methodology for image acquisition and suggest specific microvascular parameters to analyze SDF imaging studies of the intestinal mucosa microcirculation in patients with ileostomy. Proposed scoring system needs to be validated in further clinical studies.
在临床环境中，侧流暗视野（SDF）成像主要通过研究回肠造口术患者的肠黏膜，为肠道微循环提供了前所未有的见解。在床边可视化回肠黏膜的微血管结构和功能为临床研究带来了独特的机会，尤其是在危重症患者中。几篇专注于肠道微循环的论文采用了不同的评估方法，因为目前尚无公认的评分系统，因此毫不奇怪，很难比较这些研究的结果。本文提出了关于图像采集特定方面的建议，并根据一次圆桌会议参与者的建议，提出了一些用于描述人体研究中肠道微循环的参数。
圆桌会议参与者回顾了所有相关文献，讨论了SDF技术在回肠造口术患者中图像采集的各个方面以及肠道黏膜微循环描述的参数。确定了高质量和可重复图像记录的选定关键条件。为了评估肠道微循环质量，提出并描述了选定的参数和评分系统。
对于回肠造口术的图像采集，提出了五个关键点：最佳时机、最佳SDF设备探头定位、最佳稳定性、采集视频记录的最佳数量和长度以及最佳避免压力伪影。关于图像分析，已提出了一套简化的用于临床研究描述肠道黏膜微循环的定量和定性参数：每个绒毛的血管、微血管血流指数、灌注绒毛的比例以及绒毛边界。所提出的参数可纳入半定量评分系统；然而，该评分系统需要进一步验证。这种简化分析不需要复杂的软件，可在视频屏幕上手动进行。
我们提出了一种简单的图像采集方法，并建议了特定的微血管参数来分析回肠造口术患者肠道黏膜微循环的SDF成像研究。提出的评分系统需要在进一步的临床研究中进行验证。
