Routine Microcirculation Measurements in Intensive Care Unit Patients and Validation by PiCCO Technology.
ROUMI-study

The fundamental aim of resuscitation of critically ill patients is to restore tissue perfusion and oxygenation. Systemic macro-hemodynamic parameters are conventionally used to assess and monitor resuscitation success in routine clinical practice, assuming that tissue perfusion and oxygenation recover parallel to systemic hemodynamic parameters. However, tissue perfusion and oxygenation may remain impaired despite correction of systemic circulatory parameters. This loss of association between the systemic and microcirculation is referred to as a loss of ‘hemodynamic coherence. Direct visualization of sublingual microcirculation using hand-held video microscopes such as the Cytocam-IDF (Braedius Medical, Huizen the Netherland) imaging device can be used to identify such loss of hemodynamic coherence and may provide an opportunity to monitor resuscitation therapy and allows more physiologically based approaches for the diagnosis and treatment of intensive care patients. However, it has not been correlated with an invasive and gold standard hemodynamic monitoring tool such as PiCCO technology. PiCCO monitorization is one of the most common invasive technique used to assess systemic hemodynamic status in severe critically ill patients. However most clinical used and strongly evidence based parameters are still cardiac index and stroke volume index. Therefore, we especially sought to compare the microcirculatory parameters which indicates adequate tissue perfusion, MFI, TVD, PVD and PPV, to cardiac index (CI) and stroke volume index (SVI). For better quantification we will compare alterations in Microvascular Flow Index with cut off value of 2.6 AU directly with alterations in CI at minimal level of 2.2 L/kg/m2 where lower values in both parameters are highly correlating shock and are associated with mortality in the ICU.
With this project, we aim to validate Cytocam-IDF imaging as a routine monitoring tool in critically ill patients. To this end, we will compare Cytocam-IDF imaging to an invasive hemodynamic monitorization tool (PiCCO) in terms of comparability and linearity in critically ill patients.

With this project, we aim to assess the correlation of PiCCO technology and Cytocam-IDF imaging as a routine monitoring tool in critically ill patients with circulatory compromise. To this end, we expect that there will be a comparability and linearity in critically ill patients which will result in quick and non-invasive monitoring of the circulation.

Daily

Fluid and vasopressor use during resuscitation of critically ill patients.