Kintrup Sebastian, Listkiewicz Lukasz, Arnemann Philip-Helge, Wagner Nana-Maria
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany.
Crit Care. 2024 Dec 3;28(1):400. doi: 10.1186/s13054-024-05194-6.
Loss of hemodynamic coherence is a phenomenon in critically ill patients. Due to inflammatory events and endothelial remodeling, macro- and microhemodynamics are decoupled from each other, resulting in microcirculatory disturbances and end organ ischemia despite adequate vital parameters. So far, quantification of perfusion of vessels with < 100 μm diameter on the intensive care unit (ICU) was regularly performed with incident darkfield (IDF) microscopy. Nailfold videocapillaroscopy (NVC), however, is an established and easy method for visualization of the microcirculation in chronic diseases. We here evaluated NVC in critically ill patients and compared its use with consensus microcirculatory assessment of IDF-microscopy.
A new score, the capillary microcirculation (CapMic) score summarizing the microcirculation of the nail fold at four regions of digitus III, IV and V in a number between 0 (= no microcirculation) and 1 (= completely preserved microcirculation) was first established in 10 healthy volunteers and compared to the Microangiopathy Evolution Score (MES) standardized for NVC in chronic diseases. Then, n = 60 critically ill patients were recruited from a surgical ICU. Consensus-defined IDF scores and NCV data were compared at a single time point.
Evaluation of the CapMic score in 10 healthy volunteers at rest and under iatrogenic limb ischemia showed robust changes (0.80 ± 0.03 vs. 0.51 ± 0.12, p < 0.001). In critically ill patients, the IDF microscopy parameters "proportion of perfused vessels" (PPV) and "microvascular flow index" (MFI) inversely correlated with the MES (Spearman's R = -0.590, p < 0.001; Spearman's R = -0.585, p < 0.001). There was a positive correlation between PPV and the CapMic score (Spearman's R = 0.714, p < 0.001) and between MFI and the CapMic score (Spearman's R = 0.711, p < 0.001) and an inverse correlation between MES and the CapMic score (Spearman's R = -0.610, p < 0.001). Both sublingual and nailfold microcirculation deteriorated under rising norepinephrine- and crystalloid volume-requirements.
NVC-imaging provides comparable information on the microcirculation in critically ill patients compared to sublingual IDF microscopy. NCV could represent a new, additional method for diagnosing microcirculatory parameters on the ICU.
血流动力学失相干是危重症患者中出现的一种现象。由于炎症事件和内皮重塑，宏观和微观血流动力学相互解耦，导致尽管生命体征参数正常，但仍出现微循环障碍和终末器官缺血。到目前为止，重症监护病房（ICU）中对直径<100μm血管灌注的定量通常采用入射式暗场（IDF）显微镜检查。然而，甲襞微血管造影术（NVC）是一种用于观察慢性疾病微循环的成熟且简便的方法。我们在此评估了危重症患者的NVC，并将其与IDF显微镜检查的共识微循环评估方法进行了比较。
首先在10名健康志愿者中建立了一种新的评分系统，即甲襞微循环（CapMic）评分，该评分系统总结了第三、四、五指四个区域甲襞的微循环情况，评分范围为0（=无微循环）至1（=微循环完全保留），并与针对慢性病NVC标准化的微血管病变演变评分（MES）进行比较。然后，从外科ICU招募了n = 60名危重症患者。在单个时间点比较了共识定义的IDF评分和NCV数据。
对10名健康志愿者在静息状态和医源性肢体缺血情况下的CapMic评分评估显示出显著变化（0.80±0.03对0.51±0.12，p<0.001）。在危重症患者中，IDF显微镜检查参数“灌注血管比例”（PPV）和“微血管血流指数”（MFI）与MES呈负相关（Spearman's R = -0.590，p<0.001；Spearman's R = -0.585，p<0.001）。PPV与CapMic评分之间呈正相关（Spearman's R = 0.714，p<0.001），MFI与CapMic评分之间呈正相关（Spearman's R = 0.711，p<0.001），MES与CapMic评分之间呈负相关（Spearman's R = -0.610，p<0.001）。随着去甲肾上腺素和晶体液需求量的增加，舌下和甲襞微循环均恶化。
与舌下IDF显微镜检查相比，NVC成像可提供关于危重症患者微循环的可比信息。NVC可代表一种在ICU诊断微循环参数的新的补充方法。
