Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit: the GlycoNurse study

Autor: Marc Urban, Hermann Pavenstädt, Alexandros Rovas, Philipp Kümpers, Jan Sackarnd, Hans Vink, Alexander-Henrik Lukasz
Přispěvatelé: Fysiologie, RS: CARIM - R3.03 - Cerebral small vessel disease
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Resuscitation
ENDOTHELIAL GLYCOCALYX
Intraclass correlation
030204 cardiovascular system & hematology
ADHESION
Critical Care and Intensive Care Medicine
DISEASE
law.invention
0302 clinical medicine
law
Medicine
Original Research
Sidestream darkfield microscopy
PLASMA
lcsh:Medical emergencies. Critical care. Intensive care. First aid
ASSOCIATION
Middle Aged
Intensive care unit
Intensive Care Units
Point-of-Care Testing
Anesthesia
Emergency Medicine
Female
PERMEABILITY BARRIER
Emergency Service
Hospital
Adult
Glycocalyx
Sepsis
03 medical and health sciences
Intravital microscopy
Tongue
INJURY
Humans
Aged
Reproducibility
business.industry
Microcirculation
Mouth Mucosa
MICROCIRCULATORY ALTERATIONS
Reproducibility of Results
030208 emergency & critical care medicine
Emergency room
Gold standard (test)
lcsh:RC86-88.9
medicine.disease
Perfused boundary region
DYSFUNCTION
Systemic inflammatory response syndrome
SEVERE SEPSIS
Endothelium
Vascular
business
Zdroj: Scandinavian Journal of Trauma Resuscitation & Emergency Medicine, 26:16. BioMed Central
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 26, Iss 1, Pp 1-8 (2018)
ISSN: 1757-7241
Popis: Background Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU). Methods The observational study included 70 patients admitted to the ER or ICU of a university hospital. A physician and the nurse in charge of the patient performed sublingual microcirculatory measurements using sidestream dark field (SDF) imaging. A novel data acquisition and analysis software (GlycoCheck™) was used to analyze the perfused boundary region (PBR), an inverse parameter of endothelial glycocalyx dimensions in vessels with diameters of between 5 and 25 μm. Results The method showed a good intra-observer reproducibility. Specifically, intraclass correlation coefficient analysis showed an excellent reproducibility between the physician’s measurements (0.77 [CI 95%: 0.52–0.89]). The bias between the two PBRs was − 0.077 ± 0.24 μm. Moreover, there were no significant differences in the PBR values obtained by the nurses when compared to those reported by the physician (regarded as the “gold standard” measurement). Intraclass correlation coefficient analysis showed excellent reproducibility between the nurses’ and physician’s PBRs (0.75 [95% CI: 0.52–0.87]). The mean difference between the two PBRs (i.e., the bias) was 0.007 ± 0.25 μm. The nurses’ PBR assessment had a 90% sensitivity (95% CI: 60–99%) and 90% specificity (95% CI: 80–93%) to identify a severely impaired glycocalyx. Conclusion Glycocalyx dimensions can be measured at patients’ bedside precisely by non-invasive assessment of the PBR. This assessment could become part of standard monitoring and contribute to clinical decision-making and resuscitation protocols in clinical trials and daily practice. Electronic supplementary material The online version of this article (10.1186/s13049-018-0483-4) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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