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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study

Authors: Claudia Scorcella, Elisa Damiani, Roberta Domizi, Silvia Pierantozzi, Stefania Tondi, Andrea Carsetti, Silvia Ciucani, Valentina Monaldi, Mara Rogani, Benedetto Marini, Erica Adrario, Rocco Romano, Can Ince, E. Christiaan Boerma, Abele Donati

Published in: Annals of Intensive Care | Issue 1/2018

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Abstract

Background

Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in mixed group of Intensive Care Unit (ICU)-patients and to establish the association between (the evolution of) microcirculatory alterations and outcome.

Methods

This is a prospective longitudinal observational single-centre study in adult patients admitted to a 12-bed ICU in an Italian teaching hospital. Sublingual microcirculation was evaluated daily, from admission to discharge/death, using Sidestream Dark Field imaging. Videos were analysed offline to assess flow and density variables. Laboratory and clinical data were recorded simultaneously. A priori, a Microvascular Flow Index (MFI) < 2.6 was defined as abnormal. A binary logistic regression analysis was performed to evaluate the association between microcirculatory variables and outcomes; a Kaplan–Meier survival curve was built. Outcomes were ICU and 90-day mortality.

Results

A total of 97 patients were included. An abnormal MFI was present on day 1 in 20.6%, and in 55.7% of cases during ICU admission. Patients with a baseline MFI < 2.6 had higher ICU, in-hospital and 90-day mortality (45 vs. 15.6%, p = 0.012; 55 vs. 28.6%, p = 0.035; 55 vs. 26%, p = 0.017, respectively). An independent association between baseline MFI < 2.6 and outcome was confirmed in a binary logistic analysis (odds ratio 4.594 [1.340–15.754], p = 0.015). A heart rate (HR) ≥ 90 bpm was an adjunctive predictor of mortality. However, a model with stepwise inclusion of mean arterial pressure < 65 mmHg, HR ≥ 90 bpm, lactate > 2 mmol/L and MFI < 2.6 did not detect significant differences in ICU mortality. In case an abnormal MFI was present on day 1, ICU mortality was significantly higher in comparison with patients with an abnormal MFI after day 1 (38 vs. 6%, p = 0.001), indicating a time-dependent significant difference in prognostic value.

Conclusions

In a general ICU population, an abnormal microcirculation at baseline is an independent predictor for mortality. In this setting, additional routine daily microcirculatory monitoring did not reveal extra prognostic information. Further research is needed to integrate microcirculatory monitoring in a set of commonly available hemodynamic variables.
Trial registration NCT 02649088, www.​clinicaltrials.​gov. Date of registration: 23 December 2015, retrospectively registered
Appendix
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Literature
1.
2.
Kanoore Edul VS, Ince C, Dubin A. What is microcirculatory shock? Curr Opin Crit Care. 2015;21(3):245–52.CrossRefPubMed
3.
Spanos A, Jhanji S, Vivian-Smith A, et al. Early microvascular changes in sepsis and severe sepsis. Shock. 2010;33(4):387–91.CrossRefPubMed
4.
Bateman RM, Sharpe MD, Ellis CG. Bench-to-bedside review: microvascular dysfunction in sepsis–hemodynamics, oxygen transport, and nitric oxide. Crit Care. 2003;7(5):359–73.CrossRefPubMedPubMedCentral
5.
Tachon G, Harrois A, Tanaka S, et al. Microcirculatory alterations in traumatic hemorrhagic shock. Crit Care Med. 2014;42(6):1433–41.CrossRefPubMed
6.
van Genderen ME, Lima A, Akkerhuis M, et al. Persistent peripheral and microcirculatory perfusion alterations after out-of-hospital cardiac arrest are associated with poor survival. Crit Care Med. 2012;40(8):2287–94.CrossRefPubMed
7.
De Backer D, Donadello K, Sakr Y, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013;41(3):791–9.CrossRefPubMed
8.
Trzeciak S, Dellinger RP, Parrillo JE, et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med. 2007;49(1):88–98.CrossRefPubMed
9.
Jhanji S, Lee C, Watson D, et al. Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med. 2009;35(4):671–7.CrossRefPubMed
10.
den Uil CA, Lagrand WK, van der Ent M, et al. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2010;31(24):3032–9.CrossRef
11.
Sakr Y, Dubois MJ, De Backer D, et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32(9):1825–31.CrossRefPubMed
12.
Top APC, Ince C, de Meij N, et al. Persistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care. Crit Care Med. 2011;39(1):8–13.CrossRefPubMed
13.
Goedhart PT, Khalilzada M, Bezemer R, et al. Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2007;15(23):15101–14.CrossRefPubMed
14.
De Backer D, Creteur J, Dubois MJ, et al. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147(1):91–9.CrossRefPubMed
15.
Vellinga NAR, Boerma EC, Koopmans M, et al. International study on microcirculatory shock occurrence in acutely ill patients. Crit Care Med. 2015;43(1):48–56.CrossRefPubMed
16.
Damiani E, Ince C, Scorcella C, et al. Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients. J Clin Monit Comput. 2017;31(5):981–8.CrossRefPubMed
17.
18.
19.
Boerma EC, Mathura KR, van der Voort PHJ, et al. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care. 2005;9(6):R601–6.CrossRefPubMedPubMedCentral
20.
Pranskunas A, Koopmans M, Koetsier PM, et al. Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy. Intensive Care Med. 2013;39(4):612–9.CrossRefPubMed
21.
Trzeciak S, McCoy JV, Phillip Dellinger R, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med. 2008;34(12):2210–7.CrossRefPubMedPubMedCentral
22.
Hoke RS, Müller-Werdan U, Lautenschläger C, et al. Heart rate as an independent risk factor in patients with multiple organ dysfunction: a prospective, observational study. Clin Res Cardiol. 2012;101(2):139–47.CrossRefPubMed
23.
Schmittinger CA, Torgersen C, Luckner G, et al. Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med. 2012;38(6):950–8.CrossRefPubMed
24.
Disegni E, Goldbourt U, Reicher-Reiss H, et al. The predictive value of admission heart rate on mortality in patients with acute myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. J Clin Epidemiol. 1995;48(10):1197–205.CrossRefPubMed
25.
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.CrossRefPubMed
26.
Edul VSK, Enrico C, Laviolle B, et al. Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med. 2012;40(5):1443–8.CrossRefPubMed
27.
Arnold RC, Parrillo JE, Phillip Dellinger R, et al. Point-of-care assessment of microvascular blood flow in critically ill patients. Intensive Care Med. 2009;35(10):1761–6.CrossRefPubMed
Metadata
Title
MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study
Authors
Claudia Scorcella
Elisa Damiani
Roberta Domizi
Silvia Pierantozzi
Stefania Tondi
Andrea Carsetti
Silvia Ciucani
Valentina Monaldi
Mara Rogani
Benedetto Marini
Erica Adrario
Rocco Romano
Can Ince
E. Christiaan Boerma
Abele Donati
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-018-0411-9

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