Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine |
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| Authors: | Can Ince E. Christiaan Boerma Maurizio Cecconi Daniel De Backer Nathan I. Shapiro Jacques Duranteau Michael R. Pinsky Antonio Artigas Jean-Louis Teboul Irwin K. M. Reiss Cesar Aldecoa Sam D. Hutchings Abele Donati Marco Maggiorini Fabio S. Taccone Glenn Hernandez Didier Payen Dick Tibboel Daniel S. Martin Alexander Zarbock Xavier Monnet Arnaldo Dubin Jan Bakker Jean-Louis Vincent Thomas W. L. Scheeren On behalf of the Cardiovascular Dynamics Section of the ESICM |
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| Affiliation: | 1.Department of Intensive Care,Erasmus MC University Medical Center Rotterdam,Rotterdam,The Netherlands;2.Department of Translational Physiology,Academic Medical Center,Amsterdam,The Netherlands;3.Department of Intensive Care,Medical Centre Leeuwarden,Leeuwarden,The Netherlands;4.Anaesthesia and Intensive Care,St George’s Hospital and Medical School,London,UK;5.Department of Intensive Care, CHIREC Hospitals,Université Libre de Bruxelles,Brussels,Belgium;6.Department of Emergency Medicine and Center for Vascular Biology Research,Beth Israel Deaconess Medical Center and Harvard Medical School,Boston,USA;7.Anesthesia and Intensive Care Department,H?pitaux Universitaires Paris-Sud, Université Paris-Sud, H?pital De Bicêtre, Assistance Publique H?pitaux de Paris,Le Kremlin-Bicêtre,France;8.Department of Critical Care Medicine,University of Pittsburgh,Pittsburgh,USA;9.Critical Care Center, Hospital de Sabadell, CIBER Enfermedades Respiratorias,Universidad Autónoma de Barcelona,Sabadell,Spain;10.Service de Réanimation Médicale H?pital de Bicêtre,H?pitaux Universitaires Paris-Sud, AP-HP,Le Kremlin-Bicêtre,France;11.Department of Pediatrics, Division of Neonatology,Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center,Rotterdam,The Netherlands;12.Department of Anesthesiology and Surgical Critical Care,Hospital Universitario Rio Hortega,Valladolid,Spain;13.Kings College Hospital,London,UK;14.Anesthesia and Intensive Care Unit,Università Politecnica delle Marche,Ancona,Italy;15.Medical Intensive Care Unit,University Hospital of Zurich,Zurich,Switzerland;16.Department of Intensive Care,H?pital Erasme,Brussels,Belgium;17.Departamento de Medicina Intensiva, Facultad de Medicina,Pontificia Universidad Católica de Chile,Santiago,Chile;18.Department of Anesthesiology and Critical Care, Lariboisière Hospital,University of Paris Denis Diderot 7,Paris,France;19.Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center,Sophia Children’s Hospital,Rotterdam,The Netherlands;20.Intensive Care Unit,University College London,London,UK;21.Division of Surgery and Interventional Science,Royal Free Hospital,London,UK;22.Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine,University Hospital Münster,Munster,Germany;23.Servicio de Terapia Intensiva,Sanatorio Otamendi y Miroli,Buenos Aires,Argentina;24.Department of Pulmonology and Critical Care Medicine,Columbia University Medical Center,New York,USA;25.Department of Anesthesiology, University Medical Center Groningen,University of Groningen,Groningen,The Netherlands |
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| Abstract: | PurposeHand-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.MethodsIn 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.ResultsIn 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.ConclusionThis consensus describes 25 statements regarding the acquisition and interpretation of microcirculatory images needed to guide the assessment of the microcirculation in critically ill patients. |
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