Abstract
The microcirculation is the final station for oxygen transport to the tissues and plays a key role in the cardiovascular system [1]. The microcirculation includes all the vessels that are smaller than 100 micrometer in diameter and has a crucial role in blood and tissue interactions in physiological and pathophysiological states. Many studies have demonstrated that persistent microcirculatory alterations that are unresponsive to therapy are independently associated with adverse outcome, especially in septic patients (e. g., [1–5]). Additionally, these microcirculatory alterations are independent of systemic hemodynamic variables; therefore, microcirculatory observations are a potentially important extension of conventional systemic hemodynamic monitoring of critically ill patients [3,4]. These findings have been made possible by introduction of hand-held microscopes to surgery and intensive care and in this chapter we present the latest generation of these hand-held devices.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ince C (2005) The microcirculation is the motor of sepsis. Crit Care 9(4):S13–S19
De Backer D, Donadello K, Sakr Y et al (2013) Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 41:791–799
Top AP, Ince C, de Meij N, van Dijk M, Tibboel D (2011) Persistent low microcirculatory vessel density in nonsurvivors of sepsis in the pediatric intensive care. Crit Care Med 39:8–19
Edul VS, Enrico C, Laviolle B, Vazquez AR, Ince C, Dubin A (2012) Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med 40:1443–1448
Trzeciak S, Dellinger RP, Parrillo JE et al (2007) Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med 49:88–98
Groner W, Winkelman JW, Harris AG et al (1999) Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 5:1209–1212
Mathura KR, Bouma GJ, Ince C (2001) Abnormal microcirculation in brain tumours during surgery. Lancet 358:1698–1699
Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C (2007) Sidestream dark field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express 15:15101–15114
Mik EG, Johannes T, Fries M (2009) Clinical microvascular monitoring: a bright future without a future? Crit Care Med 37:2980–2981
Sherman H, Klausner S, Cook WA (1971) Incident dark-field illumination: a new method for microcirculatory study. Angiology 22:295–303
DonatiA, Tibboel D, Ince C (2013) Towards integrative physiological monitoring of the critically ill: from cardiovascular to microcirculatory and cellular function monitoring at the bedside. Crit Care 17(1):5
Klijn E, Den Uil CA, Bakker J, Ince C (2009) The heterogeneity of the microcirculation in critical illness. Clin Chest Med 29:643–654
van Golen RF, van Gulik TM, Heger M (2012) Free Mechanistic overview of reactive species-induced degradation of the endothelial glycocalyx during hepatic ischemia/reperfusion injury. Free Rad Biol Med 52:1382–1402
Boerma EC, Ince (2010) The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients. Intensive Care Med 36:2004–2018
Levick JR, Michel CC (2010) Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 87:198–210
Vincent JL, Ince C, Bakker J (2012) Clinical review: Circulatory shock – an update: a tribute to Professor Max Harry Weil. Crit Care 16:239–243
American College of Chest Physician, Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283:445–447
Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJC (1971) A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 27:392–396
Bland RD, Shoemaker WC, Abraham E, Cobo JC (1985) Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients. Crit Care Med 13:85–90
Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186
Hayes MA, Timmins AC, Yau EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevtion of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722
Ince C, Sinaasappel M (1999) Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 277:H1532–H1539
De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL (2004) Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 147:91–99
Pranskunas A, Koopmans M, Koetsier PM, Pilvinis V, Boerma EC (2013) Microcirculatory blood flow as a tool to select ICU patients eligible for fluid therapy. Intensive Care Med 39:612–619
Atasever B, Boer C, Speekenbrink R et al (2011) Cardiac displacement during off-pump coronary artery bypass grafting surgery: effect on sublingual microcirculation and cerebral oxygenation. Interact Cardiovasc Thorac Surg 13:573–577
Hernandez G, Bruhn A, Ince C (2013) Microcirculation in sepsis: new perspectives. Curr Vasc Pharmacol 11:161–169
Xu J, Ma L, Sun S, Lu X, Wu X, Li Z, Tang W (2013) Fluid resuscitation guided by sublingual partial pressure of carbon dioxide during hemorrhagic shock in a porcine model. Shock 39:361–365
Schultz SG (2002) William Harvey and the circulation of the blood: the birth of a scientific revolution and modern physiology. News Physiol Sci 17:175–180
Harvey W (1628) Exercitato anatomica de motu cordis et sanguinis in animalibus. Francofurti
Malpighi M (1661) De pulmonibus observationes anatomicae. , Bologna
Ford BJ (1995) First steps in experimental microscopy, Leeuwenhoek as practical scientist. The Microscope 43:47–57
Krahl VE (1962) Observations on the pulmonary alveolus and its capillary circulation in the living rabbit. Anat Rec 142:350
Slaaf DW, Tangelder GJ, Reneman RS, Jaeger K, Bollinger A (1987) A versatile incident illuminator for intravital microscopy. Int J Microcirc Clin Exp 6:391–397
Mathura KR, Vollebrecht KC, Boer K, de Graaf JC, Ubbink DT, Ince C (2001) Comparison of OPS imaging to intravital capillarosopy of nail fold microcirculation. J Appl Physiol 91:74–78
De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104
Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF (2002) Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 360:1395–1396
Goedhart PT, Khalilzada M, Bezemer R, Merza J, Ince C (2007) Sidestream dark field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express 15:15101–15114
Dobbe JGG, Streekstra GJ, Atasever B, van Zijderveld R, Ince C (2008) Measurement of functional microcirculatory geometry and velocity distributions using automated image analysis. Med Biol Eng Comput 46:659–670
Sallisalmi M, Oksala N, Pettilä V, Tenhunen J (2012) Evaluation of sublingual microcirculatory blood flow in the critically ill. Acta Anaesthesiol Scand 56:298–306
Massey M, LaRochelle E, Najarro G et al (2013) The microcirculation image quality score: development and preliminary evaluation of a proposed approach to grading quality of image acquisition for bedside videomicroscopy. J Crit Care 28:913–917
De Backer D, Hollenberg S, Boerma C et al (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101
Boerma EC, Mathura KR, van der Voort PHJ, Spronk PE, Ince C (2005) Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Critical Care 9:R601–R606
Elbers PE, Ince C (2006) Mechanisms of critical illness: Classifying microcirculatory flow abnormalities in distributive shock. Crit Care 10:221–299
Lindert J, Werner J, Redlin M, Kuppe H, Habazettl H, Pries AR (2002) OPS imaging of human circulation: a short technical report. J Vasc Res 39:368–372
Bezemer R, Dobbe JG, Bartels SA et al (2011) Rapid automatic assessment of microvascular density in sidestream dark field images. Med Biol Eng Comput 49:1269–1278
Bezemer R, Bartels SA, Bakker J, Ince C (2012) Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill– where do we stand? Crit Care 16(3):224
Milstein DMJ, Romay E, Ince C (2012) A novel computer-controlled high resolution video microscopy imaging system enables measuring mucosal subsurface focal depth for rapid acquisition of oral microcirculation video images. Intensive Care Med 38(1):S271
Weil MH, Tang W (2007) Welcoming a new era of hemodynamic monitoring: expanding from the macro to the microcirculation. Crit Care Med 35:1204–1205
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Aykut, G., Ince, Y., Ince, C. (2014). A New Generation Computer-controlled Imaging Sensor-based Hand-held Microscope for Quantifying Bedside Microcirculatory Alterations. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_28
Download citation
DOI: https://doi.org/10.1007/978-3-319-03746-2_28
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-03745-5
Online ISBN: 978-3-319-03746-2
eBook Packages: MedicineMedicine (R0)