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Published in: Journal of Clinical Monitoring and Computing 5/2017

01-10-2017 | Original Research

Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients

Authors: Elisa Damiani, Can Ince, Claudia Scorcella, Roberta Domizi, Andrea Carsetti, Nicoletta Mininno, Silvia Pierantozzi, Erica Adrario, Rocco Romano, Paolo Pelaia, Abele Donati

Published in: Journal of Clinical Monitoring and Computing | Issue 5/2017

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Abstract

We aimed to assess the impact of image quality on microcirculatory evaluation with sidestream dark-field (SDF) videomicroscopy in critically ill patients and explore factors associated with low video quality. This was a retrospective analysis of a single-centre prospective observational study. Videos of the sublingual microcirculation were recorded using SDF videomicroscopy in 100 adult patients within 12 h from admittance to the intensive care unit and every 24 h until discharge/death. Parameters of vessel density and perfusion were calculated offline for small vessels. For all videos, a quality score (−12 = unacceptable, 1 = suboptimal, 2 = optimal) was assigned for brightness, focus, content, stability, pressure and duration. Videos with a total score ≤8 were deemed as unacceptable. A total of 2455 videos (853 triplets) was analysed. Quality was acceptable in 56 % of videos. Lower quality was associated with worse microvascular density and perfusion. Unreliable triplets (≥1 unacceptable or missing video, 65 % of total) showed lower vessel density, worse perfusion and higher flow heterogeneity as compared to reliable triplets (p < 0.001). Quality was higher among triplets collected by an extensively-experienced investigator or in patients receiving sedation or mechanical ventilation. Perfused vessel density was higher in patients with Glasgow Coma Scale (GCS) ≤8 (18.9 ± 4.5 vs. 17.0 ± 3.9 mm/mm2 in those with GCS >8, p < 0.001) or requiring mechanical ventilation (18.0 ± 4.5 vs. 17.2 ± 3.8 mm/mm2 in not mechanically ventilated patients, p = 0.059). We concluded that SDF video quality depends on both the operator’s experience and patient’s cooperation. Low-quality videos may produce spurious data, leading to an overestimation of microvascular alterations.
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Metadata
Title
Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients
Authors
Elisa Damiani
Can Ince
Claudia Scorcella
Roberta Domizi
Andrea Carsetti
Nicoletta Mininno
Silvia Pierantozzi
Erica Adrario
Rocco Romano
Paolo Pelaia
Abele Donati
Publication date
01-10-2017
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 5/2017
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-016-9924-7

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