Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands.
Intensive Care Med. 2018 Mar;44(3):281-299. doi: 10.1007/s00134-018-5070-7. Epub 2018 Feb 6.
Hand-held vital microscopes (HVMs) were introduced to observe sublingual microcirculatory alterations at the bedside in different shock states in critically ill patients. This consensus aims to provide clinicians with guidelines for practical use and interpretation of the sublingual microcirculation. Furthermore, it aims to promote the integration of routine application of HVM microcirculatory monitoring in conventional hemodynamic monitoring of systemic hemodynamic variables.
In accordance with the Delphi method we organized three international expert meetings to discuss the various aspects of the technology, physiology, measurements, and clinical utility of HVM sublingual microcirculatory monitoring to formulate this consensus document. A task force from the Cardiovascular Dynamics Section of the European Society of Intensive Care Medicine (with endorsement of its Executive Committee) created this consensus as an update of a previous consensus in 2007. We classified consensus statements as definitions, requirements, and/or recommendations, with a minimum requirement of 80% agreement of all participants.
In this consensus the nature of microcirculatory alterations is described. The nature of variables, which can be extracted from analysis of microcirculatory images, is presented and the needed dataset of variables to identify microcirculatory alterations is defined. Practical aspects of sublingual HVM measurements and the nature of artifacts are described. Eleven statements were formulated that pertained to image acquisitions and quality statements. Fourteen statements addressed the analysis of the images, and 13 statements are related to future developments.
This consensus describes 25 statements regarding the acquisition and interpretation of microcirculatory images needed to guide the assessment of the microcirculation in critically ill patients.
手持式生命显微镜（HVM）被引入到床边，用于观察不同类型休克状态下危重病患者的舌下微循环变化。本共识旨在为临床医生提供实用的指导，以解释舌下微循环的变化。此外，它旨在促进常规应用 HVM 微循环监测与全身血流动力学变量常规血流动力学监测的整合。
根据 Delphi 方法，我们组织了三次国际专家会议，讨论了 HVM 舌下微循环监测技术、生理学、测量和临床应用的各个方面，以制定本共识文件。欧洲重症监护医学学会心血管动力学分会的一个工作组（得到其执行委员会的认可）制定了本共识，作为 2007 年之前的一项共识的更新。我们将共识声明分为定义、要求和/或建议，所有参与者的最低共识要求为 80%。
在本共识中，描述了微循环变化的性质。呈现了可以从微循环图像分析中提取的变量的性质，以及定义了识别微循环变化所需的变量数据集。描述了舌下 HVM 测量的实际方面和伪影的性质。制定了 11 项与图像采集和质量声明有关的声明。14 项声明涉及图像分析，13 项声明与未来发展有关。
本共识描述了 25 项关于获取和解释微循环图像的声明，以指导对危重病患者微循环的评估。
