ABSTRACTS from 16th International COnference on ... - CRRT Online

A01
Assessing the Microcirculation
Can Ince PhD
4:00-5:30
Tuesday, February 14
Educational Objectives:
• Discuss the physiology of the microcirculation and the parameters which defines its function in different
organs. Discuss the physiological determinants of perfusion and oxygenation of the microcirculation and how
these can be measured in the clinical scenario
• Discuss the latest developments in the bed side assessment of the microcirculation and their meaning in terms
of prognosis and response to therapy.
• Practical demonstration of the use of sublingual SDF imaging
Content Description:
In this lecture we will discuss the (patho)physiological significance of microcirculatory alterations in clinical
states of sepsis, shock and resuscitation and how its monitoring at the bed side has played a central role in identifying
its significance. Besides the clinical background of microcirculatory , the methods both in terms of hardware
and analysis methods will be discussed. Following this recent improvements in the techniques of monitoring
and interpretation of microcirculatory alterations in critical illness as measured by direct sublingual microcirculation
observation. We will present our new developed software which gives instant evaluation of the images
as well as improvements in the devices for reducing pressure artefacts. A new improved imaging device will be
presented. Next a new internet platform will be presented for allowing international exchange of images and setting
the scene for multi-central intervention trials with as goal the improvement of the microcirculation to be
held. In this context the progress of epidemiological survey of microcirculatory alterations (perfusion as well
oxygenation) in the critically ill patients will be presented.
Suggested Reading:
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. Optics Express 15: 15101-15114
Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL present a study entitled (2004) Persistent microcirculatory alterations
are associated with organ failure and death in patients with septic shock. Crit Care Med32:1825-31.
Trzeciak S, McCoy JV, Dellinger RP, Arnold RC, Rizzuto M et al (2008) Early increases in microcirculatory perfusion
uring protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis Intensive
Care Med 34(12):2210-7
Dobbe JGG, Streekstra GJ, Atasever B, van Zijderveld R, Ince C (2008) Measurement of functional microcirculatory geometry
and velocity distributions using automated image analysis. Medical & Biological Engineering & Computing Med Biol
Eng Comput. 46(7):659-70.
Arnold RC, Parrillo JE, Phillip Dellinger R, Chansky ME, Shapiro NI, Lundy DJ, Trzeciak S, Hollenberg SM. (2009) Pointof-care
assessment of microvascular blood flow in critically ill patients. Intensive Care Med. 35(10):1761-6.
Balestra GM, Bezemer R, Boerma EC, Yong ZY, Sjauw KD, Engstrom AE, Koopmans M, Ince C (2010) Improvement of
Sidestream Dark Field Imaging with an Image Acquisition Stabilizer.BMC Med Imaging. 13;10(1):15.
De Backer D, Hollenberg S, Boerma C, Goedhart P, Büchele G, Ospina-Tascon G, Dobbe I Ince C (2007) How to evaluate
the microcirculation? Report of a round table conference. Crit Care 10;11(5):R101-111.
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