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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Abstract

Hand-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.

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The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines

Melissa C. Brouwers, Kate Kerkvliet, Karen Spithoff … (2016)

AGREE II is a widely used standard for assessing the methodological quality of practice guidelines. This article describes the development of the AGREE Reporting Checklist, which was designed to improve the quality of practice guideline reporting and aligns with AGREE II in its structure and content.

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The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects.

Jean-Louis Vincent, D Backer, Marc Koch … (2006)

To evaluate the effects of dobutamine on microcirculatory blood flow alterations in patients with septic shock. Prospective, open-label study. A 31-bed, medico-surgical intensive care unit of a university hospital. Twenty-two patients with septic shock. Intravenous administration of dobutamine (5 mug/kg.min) for 2 hrs (n = 22) followed by the addition of 10 M acetylcholine (topically applied, n = 10). Complete hemodynamic measurements were obtained before and after dobutamine administration. In addition, the sublingual microcirculation was investigated with an orthogonal polarization spectral imaging technique before and after dobutamine administration and after topical application of acetylcholine. Dobutamine significantly improved capillary perfusion (from 48 +/- 15 to 67 +/- 11%, p = .001), but with large individual variation, whereas capillary density remained stable. The addition of topical acetylcholine completely restored capillary perfusion (98 +/- 1%, p = .001) and capillary density. The changes in capillary perfusion during dobutamine administration were not related to changes in cardiac index (p = .45) or arterial pressure (p = .29). Interestingly, the decrease in lactate levels was proportional to the improvement in capillary perfusion (y = 0.07 - 0.02x, r = .46, p = .005) but not to changes in cardiac index (p = .55). The administration of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock. These changes are independent of changes in systemic hemodynamic variables.

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Less invasive hemodynamic monitoring in critically ill patients.

Jean-Louis Teboul, Bernd Saugel, Maurizio Cecconi … (2016)

Over the last decade, the way to monitor hemodynamics at the bedside has evolved considerably in the intensive care unit as well as in the operating room. The most important evolution has been the declining use of the pulmonary artery catheter along with the growing use of echocardiography and of continuous, real-time, minimally or totally non-invasive hemodynamic monitoring techniques. This article, which is the result of an agreement between authors belonging to the Cardiovascular Dynamics Section of the European Society of Intensive Care Medicine, discusses the advantages and limits of using such techniques with an emphasis on their respective place in the hemodynamic management of critically ill patients with hemodynamic instability.

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Journal

Title: Intensive Care Medicine

Abbreviated Title: Intensive Care Med

Publisher: Springer Science and Business Media LLC

ISSN (Print): 0342-4642

ISSN (Electronic): 1432-1238

Publication date Created: March 2018

Publication date (Electronic): February 6 2018

Publication date (Print): March 2018

Volume: 44

Issue: 3

Pages: 281-299

Article

DOI: 10.1007/s00134-018-5070-7

PubMed ID: 29411044

SO-VID: b646463c-03d7-47f8-b86b-2767a26fad94

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http://www.springer.com/tdm

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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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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 79

The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines

The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects.

Less invasive hemodynamic monitoring in critically ill patients.

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