title: Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study.
abstract: BACKGROUND
  The introduction of orthogonal polarization spectral (OPS) imaging in clinical research has elucidated new perspectives on the role of microcirculatory flow abnormalities in the pathogenesis of sepsis. Essential to the process of understanding and reproducing these abnormalities is the method of quantification of flow scores.
  
  
  METHODS
  In a consensus meeting with collaboraters from six research centres in different fields of experience with microcirculatory OPS imaging, premeditated qualifications for a simple, translucent and reproducible way of flow scoring were defined. Consecutively, a single-centre prospective observational validation study was performed in a group of 12 patients with an abdominal sepsis and a new stoma. Flow images of the microcirculation in vascular beds of the sublingual and stoma region were obtained, processed and analysed in a standardised way. We validated intra-observer and inter-observer reproducibility with kappa cross-tables for both types of microvascular beds.
  
  
  RESULTS
  Agreement and kappa coefficients were >85% and >0.75, respectively, for interrater and intrarater variability in quantification of flow abnormalities during sepsis, in different subsets of microvascular architecture.
  
  
  CONCLUSIONS
  Semi-quantitative analysis of microcirculatory flow, as described, provides a reproducible and transparent tool in clinical research to monitor and evaluate the microcirculation during sepsis.
authors.affiliation: Department of Physiology, Academic Medical Centre, University of Amsterdam, The Netherlands. e.boerma@chello.nl
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Boerma
authors.forename: Keshen R
authors.initials: KR
authors.lastname: Mathura
authors.forename: Peter H J
authors.initials: PH
authors.lastname: van der Voort
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Can
authors.initials: C
authors.lastname: Ince
mesh_terms: D018806:APACHE; D000005:Abdomen / Q000098:blood supply*; D003125:Colostomy; D006801:Humans; D007081:Ileostomy; D007362:Intensive Care Units; D008833:Microcirculation / Q000503:physiopathology; D008859:Microscopy, Polarization / Q000379:methods; D015588:Observer Variation; D019095:Point-of-Care Systems; D011446:Prospective Studies; D018805:Sepsis / Q000145:classification / Q000503:physiopathology*; D054047:Surgical Stomas / Q000098:blood supply*