Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery

2021 ◽  
Vol 82 (7) ◽  
pp. 574-581
Author(s):  
Christelle Mansour ◽  
Rana Chaaya ◽  
Jerneja Sredensek ◽  
Rita Mocci ◽  
Bruna Santangelo ◽  
...  
Keyword(s):  
Dark Field ◽  
Video Microscopy ◽  
Intestinal Surgery ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Elective Procedure

Abstract MP61: Evidence of Impaired Microvascular Function a Decade After Delivery in Women With Placental Malperfusion Lesions

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Alisse Hauspurg ◽  
Judith Brands ◽  
Robin Gandley ◽  
Matthew F Muldoon ◽  
William Tony Parks ◽  
...  
Keyword(s):  
Disease Risk ◽  
Gestational Hypertension ◽  
Boundary Region ◽  
Dark Field ◽  
Endothelial Glycocalyx ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Dark Field Imaging ◽  
Median Diameter ◽  
History Of

Introduction: Maternal vascular malperfusion (MVM) lesions in the placenta are characterized by incomplete vascular remodeling and vessel features similar to atherosclerosis. MVM lesions indicate a maladaptive maternal vascular response to pregnancy, are often detected in hypertensive disorders of pregnancy (HDP), and may provide a pathologic link to future cardiovascular disease. The endothelial glycocalyx is a glycoprotein-rich layer that is critical for microvascular health and damage may have an important role in the pathophysiology of microcardiovascular disease risk. Hypothesis: We hypothesized that women with malperfusion lesions of the placenta are more likely to evidence microvascular glycocalyx derangement a decade after delivery compared to women without these lesions and that this effect would be most pronounced among women with a history of HDP. Methods: A total of 412 women with placental pathology (N=129 with MVM lesions, N=283 without MVM lesions) were evaluated at 8-10 years postpartum. Placental specimens were reviewed by a blinded perinatal pathologist . HDP (including preeclampsia and gestational hypertension) were abstracted from the medical record. Glycocalyx barrier function was assessed using sublingual sidestream dark field imaging, with reduction defined as deeper penetration of red blood cells (RBCs) into the glycocalyx of the sublingual microcirculation (5-25μm diameter). We compared the median diameter (size) of microvessels, penetration of RBCs into the glycocalyx (perfused boundary region, PBR) and microvascular density (total length of perfused microvessels/mm 2 surface area) in women with and without MVM lesions. Results: Women with placental MVM lesions had smaller-sized sublingual vessels (median 8.59 μM [IQR 8.12, 9.19] vs. 9.01 μM [IQR 8.37, 9.64]; p<0.001), and a lower density of vessels compared to women without lesions. Glycocalyx perfused boundary region was unexpectedly lower in women with MVM lesions (median 2.20 μM [IQR 2.06, 2.43] vs. 2.32 μM [IQR 2.15, 2.50]; p=0.003) in 10-19 μM vessels. Women with HDP and MVM lesions appear to be the most impacted, with the smallest size vessels (median 8.47 [IQR 8.09-9.13]) and the lowest glycocalyx PBR across all vessel sizes. Women with MVM lesions without a HDP similarly had evidence of microvascular glycocalyx derangement whereas women with HDP without placental lesions had a glycocalyx profile similar to women without MVM or a history of HDP. Conclusions: A decade after delivery, women with a history of placental malperfusion lesions had alterations in microvascular perfusion. Women with MVM lesions and a history of HDP appear to be the most severely impacted, which may reflect an underlying maladaptive vascular phenotype detected in the placenta at the time of pregnancy that might provide pathologic insight into future maternal microvascular health.

scholarly journals Exposure to acute normobaric hypoxia results in adaptions of both the macro- and microcirculatory system

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Moritz Mirna ◽  
Nana-Yaw Bimpong-Buta ◽  
Fabian Hoffmann ◽  
Thaer Abusamrah ◽  
Thorben Knost ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Acute Hypoxia ◽  
Capillary Density ◽  
Dark Field ◽  
Normobaric Hypoxia ◽  
Vessel Density ◽  
Resistance Arteries ◽  
Compensatory Mechanisms ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation

AbstractAlthough acute hypoxia is of utmost pathophysiologic relevance in health and disease, studies on its effects on both the macro- and microcirculation are scarce. Herein, we provide a comprehensive analysis of the effects of acute normobaric hypoxia on human macro- and microcirculation. 20 healthy participants were enrolled in this study. Hypoxia was induced in a normobaric hypoxia chamber by decreasing the partial pressure of oxygen in inhaled air stepwisely (pO2; 21.25 kPa (0 k), 16.42 kPa (2 k), 12.63 kPa (4 k) and 9.64 kPa (6 k)). Macrocirculatory effects were assessed by cardiac output measurements, microcirculatory changes were investigated by sidestream dark-field imaging in the sublingual capillary bed and videocapillaroscopy at the nailfold. Exposure to hypoxia resulted in a decrease of systemic vascular resistance (p < 0.0001) and diastolic blood pressure (p = 0.014). Concomitantly, we observed an increase in heart rate (p < 0.0001) and an increase of cardiac output (p < 0.0001). In the sublingual microcirculation, exposure to hypoxia resulted in an increase of total vessel density, proportion of perfused vessels and perfused vessel density. Furthermore, we observed an increase in peripheral capillary density. Exposure to acute hypoxia results in vasodilatation of resistance arteries, as well as recruitment of microvessels of the central and peripheral microcirculation. The observed macro- and microcirculatory effects are most likely a result from compensatory mechanisms to ensure adequate tissue oxygenation.

scholarly journals Effects of a single aerobic exercise on perfused boundary region and microvascular perfusion: a field study

2021 ◽  
Author(s):  
Alexander Fuchs ◽  
Tobias Neumann ◽  
Hendrik Drinhaus ◽  
Anika Herrmann ◽  
Hans Vink ◽  
...  
Keyword(s):  
Surface Layer ◽  
Aerobic Exercise ◽  
Linear Regression Analysis ◽  
Boundary Region ◽  
Dark Field ◽  
Microvascular Perfusion ◽  
Sidestream Dark Field ◽  
Endothelial Surface Layer ◽  
Sublingual Microcirculation ◽  
Endothelial Surface

AbstractThe endothelium and the glycocalyx play a pivotal role in regulating microvascular function and perfusion in health and critical illness. It is unknown today, whether aerobic exercise immediately affects dimensions of the endothelial surface layer (ESL) in relation to microvascular perfusion as a physiologic adaption to increased nutritional demands. This monocentric observational study was designed to determine real-time ESL and perfusion measurements of the sublingual microcirculation using sidestream dark field imaging performed in 14 healthy subjects before and after completing a 10 km trial running distance. A novel image acquisition and analysis software automatically analysed the perfused boundary region (PBR), an inverse parameter for red blood cell (RBC) penetration of the ESL, in vessels between 5 and 25 µm diameter. Microvascular perfusion was assessed by calculating RBC filling percentage. There was no significant immediate effect of exercise on PBR and RBC filling percentage. Linear regression analysis revealed a distinct association between change of PBR and change of RBC filling percentage (regression coefficient β: − 0.026; 95% confidence interval − 0.043 to − 0.009; p = 0.006). A single aerobic exercise did not induce a change of PBR or RBC filling percentage. The endothelium of the microvasculature facilitates efficient perfusion in vessels reacting with an increased endothelial surface layer.

Evaluation of a shorter algorithm in an automated analysis of sublingual microcirculation

2020 ◽  
Vol 76 (2) ◽  
pp. 287-297
Author(s):  
Raphael Romano Bruno ◽  
Mara Schemmelmann ◽  
Jakob Wollborn ◽  
Malte Kelm ◽  
Christian Jung
Keyword(s):  
Video Quality ◽  
Quality Measurement ◽  
Automated Analysis ◽  
Measurement Procedure ◽  
Dark Field ◽  
Frame Rate ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Promising Tool ◽  
Measurement Results

OBJECTIVE: Diagnostic and risk stratification in intensive and emergency medicine must be fast, accurate, and reliable. The assessment of sublingual microcirculation is a promising tool for this purpose. However, its value is limited because the measurement is time-consuming in unstable patients. This proof-of-concept validation study examines the non-inferiority of a reduced frame rate in image acquisition regarding quality, measurement results, and time. METHODS: This prospective observational study included healthy volunteers. Sublingual measurement of microcirculation was performed using a sidestream dark field camera (SDF, MicroVision Medical®). Video-quality was evaluated with a modified MIQS (microcirculation image quality score). AVA 4.3C software calculated microcirculatory parameters. RESULTS: Thirty-one volunteers were included. There was no impact of the frame rate on the time needed by the software algorithm to measure one video (4.5 ± 0.5 minutes) for AVA 4.3C. 86 frames per video provided non inferior video quality (MIQS 1.8 ± 0.7 for 86 frames versus MIQS 2.2 ± 0.6 for 215 frames, p < 0.05), equal results for all microcirculatory parameters, but did not result in an advantage in terms of speed. No complications occurred. CONCLUSION: Video captures with 86 frames offer equal video quality and results for consensus parameters compared to 215 frames. However, there was no advantage regarding the time needed for the overall measurement procedure.

scholarly journals Experience of Sublingual Microcirculation Evaluation in Adults Patients with Severe Dengue

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S360-S360
Author(s):  
Fernando Rosso ◽  
Gustavo Ospina ◽  
Edgardo Quiñones ◽  
Ana Maria Sanz
Keyword(s):  
Fluid Challenge ◽  
Significant Negative Correlation ◽  
Dark Field ◽  
Severe Dengue ◽  
Flow Index ◽  
Vascular Density ◽  
Positive Serology ◽  
Volume Depletion ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation

Abstract Background Severe microcirculatory changes are involved in the pathophysiological mechanisms that lead to irreversible final stages of dengue shock. We report our experience of the evaluation of sublingual microcirculation in adult patients with severe dengue Methods Adults patients with severe dengue (by WHO 2009 criteria) were included. Dengue diagnostics was made by positive serology for IgM / IgG, antigen NS1 or PCR. Sublingual Microcirculation (SM) was evaluated by Sidestream Dark Field imaging. Microvascular flow index (MFI), proportion of small-perfused vessels (%SVP), heterogeneity index (HI) and Total Vascular Density were calculated. All patients received Fluids Challenge (FC) at hospital admission. Results SM was assessed in 10 patients. The median age was 65 years [IQR: 34–70], 60% were male. Eight patients were admitted to the ICU, of which 63% required invasive ventilatory and vasoactive support. One patient died. After the fluid challenge, the median of the %SVP was 94 [IR: 97 – 77], the median of the MFI was 2.82 [IR: 2, 85 – 2, 14]. There were not significant differences in %SVP and MFI among the patients who survived. In the deceased patient, the %SVP with continuous flow was 59, 18% and the MFI was 1, 45; these values were significantly decreased compared with patients who survived. A significant negative correlation between hematocrit and %SVP, and MFI was found. Conclusion Initial fluid challenge, that identifies and treats volume depletion, could correct microcirculation abnormalities evaluated by SDF imaging. However, in the patient who did not respond to this challenge, significant alterations of the MFI and the %SVP were evidenced. There is a need for more studies to improve our understanding of the role of microcirculation evaluation in these patients. Disclosures All authors: No reported disclosures.

Evaluation of jejunal microvasculature of healthy anesthetized dogs with sidestream dark field video microscopy

2020 ◽  
Vol 81 (11) ◽  
pp. 888-893
Author(s):  
Kaitlyn M. Mullen ◽  
Penny J. Regier ◽  
Leonel A. Londoño ◽  
Kristina Millar ◽  
Jenny Groover
Keyword(s):  
Dark Field ◽  
Video Microscopy ◽  
Sidestream Dark Field ◽  
Anesthetized Dogs

scholarly journals Characteristics and Clinical Significance of Microcirculation in Populations Residing at Different Altitudes

2020 ◽  
Author(s):  
Siqing Ma ◽  
Zong-Zhao He ◽  
Jun-Ming Luo ◽  
Kang Song ◽  
Jing-Yuan Xu ◽  
...  
Keyword(s):  
Field Method ◽  
Dark Field ◽  
Vessel Density ◽  
Physiological Adaptation ◽  
Flow Index ◽  
Sidestream Dark Field ◽  
Blood Oxygen Saturation ◽  
Cell Parameters ◽  
Sublingual Microcirculation ◽  
Different Altitudes

Abstract Background: This study aimed to evaluate changes in microcirculation, physiological characteristics, and the pathomechanism of and potential treatment alternatives for severe septic shock among healthy individuals residing at different altitudes.Methods: Seventy individuals, 35 from Xining and 35 from Nanjing, were recruited, and their body temperature, pulse, respiration, mean arterial pressure, peripheral blood oxygen saturation, and blood cell parameters were determined. Microcirculation indices of sublingual microcirculation were monitored using the sidestream dark field method.Results: Erythrocyte counts and hemoglobin levels were significantly higher among individuals from Xining than among those from Nanjing (P < 0.05); however, platelet counts were significantly lower among those from Xining (P < 0.05). Microcirculation indices of total vessel density, perfused vessel density, and the proportion of perfused vessels were significantly higher among individuals from Xining than among those from Nanjing; however, the microvascular flow index was lower among those from Xining. Microvascular density was significantly higher among individuals from Xining than among those from Nanjing.Conclusion: Microvascular densit may be a physiological adaptation among populations at moderate-to-high altitudes.

scholarly journals Links between Endothelial Glycocalyx Changes and Microcirculatory Parameters in Septic Patients

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 790
Author(s):  
Egle Belousoviene ◽  
Inga Kiudulaite ◽  
Vidas Pilvinis ◽  
Andrius Pranskunas
Keyword(s):  
Blood Vessels ◽  
Prospective Observational Study ◽  
Microvascular Dysfunction ◽  
Dark Field ◽  
Endothelial Glycocalyx ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Endothelial Surface ◽  
Significant Damage ◽  
Video Microscope

The glycocalyx is an endothelial surface layer that is essential for maintaining microvascular homeostasis. Impaired integrity of the endothelial glycocalyx may be directly related to the development of microvascular dysfunction. To explore this hypothesis, we conducted a prospective observational study on adult patients diagnosed with sepsis. The study aimed to evaluate the degree of damage to the glycocalyx and to identify correlations between microcirculatory parameters and glycocalyx thickness based on capillary diameter. Sublingual microcirculation was examined using a handheld Cytocam-incident dark field video microscope. A sidestream dark field video microscope attached to a GlycoCheck monitor was used to determine the perfused boundary regions (PBRs) of sublingual blood vessels grouped by diameter (5–9 μm, 10–19 μm, and 20–25 μm). We identified significant damage to the glycocalyx in sublingual blood vessels of all the aforementioned diameters in septic patients compared to healthy age-matched controls. Furthermore, we found that the PBRs of the smallest capillaries (diameter class 5–9µm) correlated moderately and inversely with both total and perfused blood vessel densities. Collectively, our data suggest that there may be a functional relationship between damage to the endothelial glycocalyx of the smallest capillaries and alterations in the microcirculation observed in response to sepsis.

Abstract 16839: Maternal Placental Vascular Malperfusion Lesions Associated With Increased Cardiometabolic Risk and Reduced Microvascular Density in Women a Decade After Delivery: Which Placental Features Matter?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Robin E Gandley ◽  
Judith Brands ◽  
Carl A Hubel ◽  
Alisse Hauspurg ◽  
William Tony Parks ◽  
...  
Keyword(s):  
Cardiometabolic Risk ◽  
Later Life ◽  
Boundary Region ◽  
Dark Field ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Dark Field Imaging ◽  
Microvascular Changes ◽  
History Of ◽  
Adverse Pregnancy

Introduction: Maternal vascular malperfusion (MVM) lesions in the placenta are commonly found in women with adverse pregnancy outcomes associated with increased CVD in later life. Minimal criteria for MVM include vasculopathy, accelerated villous maturation and increased syncytial knots, and villous infarction upon pathologic examination; expanded definitions have included presence of fibrin deposition (intervillous or perivillous) or low placental weight (<10 th %). Hypothesis: Women with a history of MVM lesions would have evidence of cardiometabolic risk factors and peripheral microvascular changes a decade after delivery independent of pregnancy outcome. Methods: A total of 469 women with placental pathology data available were evaluated at 8-10 years postpartum. Placental specimens were reviewed by a perinatal pathologist. Cardiometabolic variables were measured at the time of the study visit. Sidestream dark field imaging was used to assess the sublingual microcirculation. We compared the median size (diameter) of microvessels, density (total length of perfused microvessels/mm 2 ) and penetration of red cells into the glycocalyx of vessels 5-25μm diameter (perfused boundary region, PBR) in women 8-10 years after pregnancy, using the minimal MVM criteria (compared to none). Expanded criteria were examined alone. Significance =*p<0.05 vs no MVM lesions. Results: Women with minimally defined MVM lesions in their placentas had higher diastolic blood pressure (79mmHg MVM vs. 75 mmHg No MVM*), LDL (111mg/dL MVM vs. 101 mg/dL No MVM*), Cholesterol (185 mg/dL MVM vs. 175mg/dL No MVM*) and insulin (14mg/dL MVM vs. 12mg/dL No MVM*), along with smaller-sized microvessels (median 8.75±1.1 μM vs. 9.06±0.7 μM*), and a lower density of perfused microvessels compared to women without MVM lesions (3590±1260mm/mm 2 MVM vs. 3970±820 mm/mm 2 No MVM*) a decade after delivery. Glycocalyx PBR was smaller in women with prior MVM vs. women without lesions (2.01±0.23μm vs. 2.09±0.15μm, P=0.02). Similar results were not seen in subjects with either presence of fibrin or small placenta in the absence of other MVM criteria. Discussion: Using minimal criteria MVM was associated most strongly with maternal cardiometabolic and microvascular differences a decade later.

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