Bose Rishabh, Singh Gyanendra, Singh Prachi, Sampath Ananyan, Singh Ritik, Patel Bhupeshwari, Pakhare Abhijit P, Joshi Rajnish, Khadanga Sagar
Internal Medicine, All India Institute of Medical Sciences, Bhopal, IND.
Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, IND.
Cureus. 2022 May 5;14(5):e24762. doi: 10.7759/cureus.24762. eCollection 2022 May.
Introduction The management of septic shock and refractory septic shock is essential in preventing sepsis-related death. The handheld vital microscope is a new modality of investigation for sepsis for microcirculatory assessment. This study aimed to identify predictors of inotrope requirements among patients with early sepsis and impending septic shock with particular reference to sublingual microcirculation assessment parameters. Methodology We conducted an observational cross-sectional hospital-based study in central India. The formal sample size was calculated to be 52 patients using a convenient sampling technique. The study was initiated with ethics approval (IHEC-LOP/2019/ MD0090) with consent from the patients. We used the MicroScan (MicroVision Medical, Netherlands) Video Microscope System (No.16A00102) to obtain sidestream dark-field imaging along with the AVA 4.3C software (MicroVision Medical). Results Of 51 cases, 60.8% were women, and 39.2% were men, and the study population had a mean age of 41.0 ± 14.9 years. Patients were recruited from medical wards (64.7%) and emergency departments (35.3%). The most common site of infection was gastrointestinal (33.3%), followed by respiratory infections (25.5%) and genitourinary infections (11.8%). The quick sequential organ failure assessment score was 2.0 ± 0.1. Eight patients required inotropes, and six patients died. High respiratory rates and lactate levels were important predictors of inotrope requirements in patients with early sepsis. Sublingual microcirculatory parameters at baseline did not significantly affect the requirement of inotropes consequently. Conclusions Sublingual microscopy is a suggested tool for the management of sepsis. However, without clearly defined cut-off values, handheld vital microscopy could not predict fluid responsiveness among patients with early sepsis. Also, it would be difficult to incorporate this technology into regular practice without equipment upgrades and image acquisition software.
引言 脓毒性休克和难治性脓毒性休克的管理对于预防脓毒症相关死亡至关重要。手持式活体显微镜是一种用于脓毒症微循环评估的新型检查方式。本研究旨在确定早期脓毒症和即将发生脓毒性休克患者中血管活性药物需求的预测因素，尤其参考舌下微循环评估参数。
方法 我们在印度中部进行了一项基于医院的观察性横断面研究。采用方便抽样技术，计算得出正式样本量为52例患者。该研究在获得伦理批准（IHEC-LOP/2019/MD0090）并征得患者同意后启动。我们使用MicroScan（荷兰MicroVision Medical公司）视频显微镜系统（编号16A00102）以及AVA 4.3C软件（MicroVision Medical公司）获取侧流暗视野成像。
结果 在51例病例中，女性占60.8%，男性占39.2%，研究人群的平均年龄为41.0±14.9岁。患者来自内科病房（64.7%）和急诊科（35.3%）。最常见的感染部位是胃肠道（33.3%），其次是呼吸道感染（25.5%）和泌尿生殖系统感染（11.8%）。快速序贯器官衰竭评估评分是2.0±0.1。8例患者需要血管活性药物，6例患者死亡。高呼吸频率和乳酸水平是早期脓毒症患者血管活性药物需求的重要预测因素。因此，基线时的舌下微循环参数并未显著影响血管活性药物的需求。
结论 舌下显微镜检查是脓毒症管理的一种推荐工具。然而，由于没有明确界定的临界值，手持式活体显微镜无法预测早期脓毒症患者的液体反应性。此外，如果不进行设备升级和图像采集软件更新，将这项技术纳入常规实践会很困难。
