Nailfold videocapillaroscopy - a novel method for the assessment of hemodynamic incoherence on the ICU.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE
    • Publication Information:
      Publication: London, UK : BioMed Central Ltd
      Original Publication: London : Current Science Ltd, c1997-
    • Subject Terms:
      Microscopic Angioscopy*/methods ; Intensive Care Units*/organization & administration ; Microcirculation*/physiology ; Hemodynamics*/physiology; Humans ; Female ; Male ; Middle Aged ; Aged ; Adult ; Nails/blood supply ; Critical Illness ; Capillaries/physiopathology ; Capillaries/physiology
    • Abstract:
      Background: Loss of hemodynamic coherence is a phenomenon in critically ill patients. Due to inflammatory events and endothelial remodeling, macro- and microhemodynamics are decoupled from each other, resulting in microcirculatory disturbances and end organ ischemia despite adequate vital parameters. So far, quantification of perfusion of vessels with < 100 μm diameter on the intensive care unit (ICU) was regularly performed with incident darkfield (IDF) microscopy. Nailfold videocapillaroscopy (NVC), however, is an established and easy method for visualization of the microcirculation in chronic diseases. We here evaluated NVC in critically ill patients and compared its use with consensus microcirculatory assessment of IDF-microscopy.
      Methods: A new score, the capillary microcirculation (CapMic) score summarizing the microcirculation of the nail fold at four regions of digitus III, IV and V in a number between 0 (= no microcirculation) and 1 (= completely preserved microcirculation) was first established in 10 healthy volunteers and compared to the Microangiopathy Evolution Score (MES) standardized for NVC in chronic diseases. Then, n = 60 critically ill patients were recruited from a surgical ICU. Consensus-defined IDF scores and NCV data were compared at a single time point.
      Results: Evaluation of the CapMic score in 10 healthy volunteers at rest and under iatrogenic limb ischemia showed robust changes (0.80 ± 0.03 vs. 0.51 ± 0.12, p < 0.001). In critically ill patients, the IDF microscopy parameters "proportion of perfused vessels" (PPV) and "microvascular flow index" (MFI) inversely correlated with the MES (Spearman's R = -0.590, p < 0.001; Spearman's R = -0.585, p < 0.001). There was a positive correlation between PPV and the CapMic score (Spearman's R = 0.714, p < 0.001) and between MFI and the CapMic score (Spearman's R = 0.711, p < 0.001) and an inverse correlation between MES and the CapMic score (Spearman's R = -0.610, p < 0.001). Both sublingual and nailfold microcirculation deteriorated under rising norepinephrine- and crystalloid volume-requirements.
      Conclusion: NVC-imaging provides comparable information on the microcirculation in critically ill patients compared to sublingual IDF microscopy. NCV could represent a new, additional method for diagnosing microcirculatory parameters on the ICU.
      Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of University Hospital Münster (ID: 2023–203-f-S), written informed consent was obtained by the patients themselves or their legal representatives upon study recruitment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
      (© 2024. The Author(s).)
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    • Contributed Indexing:
      Keywords: Comparison; Critical illness; Incident darkfield microscopy; Microcirculation; Nailfold videocapillaroscopy
    • Publication Date:
      Date Created: 20241203 Date Completed: 20241204 Latest Revision: 20241207
    • Publication Date:
      20241209
    • Accession Number:
      PMC11616376
    • Accession Number:
      10.1186/s13054-024-05194-6
    • Accession Number:
      39627847