title: Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients.
abstract: We aimed to assess the impact of image quality on microcirculatory evaluation with sidestream dark-field (SDF) videomicroscopy in critically ill patients and explore factors associated with low video quality. This was a retrospective analysis of a single-centre prospective observational study. Videos of the sublingual microcirculation were recorded using SDF videomicroscopy in 100 adult patients within 12 h from admittance to the intensive care unit and every 24 h until discharge/death. Parameters of vessel density and perfusion were calculated offline for small vessels. For all videos, a quality score (-12 = unacceptable, 1 = suboptimal, 2 = optimal) was assigned for brightness, focus, content, stability, pressure and duration. Videos with a total score ≤8 were deemed as unacceptable. A total of 2455 videos (853 triplets) was analysed. Quality was acceptable in 56 % of videos. Lower quality was associated with worse microvascular density and perfusion. Unreliable triplets (≥1 unacceptable or missing video, 65 % of total) showed lower vessel density, worse perfusion and higher flow heterogeneity as compared to reliable triplets (p < 0.001). Quality was higher among triplets collected by an extensively-experienced investigator or in patients receiving sedation or mechanical ventilation. Perfused vessel density was higher in patients with Glasgow Coma Scale (GCS) ≤8 (18.9 ± 4.5 vs. 17.0 ± 3.9 mm/mm2in those with GCS >8, p < 0.001) or requiring mechanical ventilation (18.0 ± 4.5 vs. 17.2 ± 3.8 mm/mm2in not mechanically ventilated patients, p = 0.059). We concluded that SDF video quality depends on both the operator's experience and patient's cooperation. Low-quality videos may produce spurious data, leading to an overestimation of microvascular alterations.
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Damiani
authors.affiliation: Department of Translational Physiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Scorcella
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Domizi
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carsetti
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Mininno
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pierantozzi
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Adrario
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Romano
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelaia
authors.affiliation: Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, via Tronto 10/a, 60126, Ancona, Italy. a.donati@univpm.it.
authors.forename: Abele
authors.identifier: http://orcid.org/0000-0001-6792-8741
authors.initials: A
authors.lastname: Donati
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D016638:Critical Illness; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008833:Microcirculation; D018715:Microscopy, Video / Q000379:methods*; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014059:Tongue / Q000098:blood supply*; D014741:Video Recording; D055815:Young Adult
keywords: Critically ill patients; Microcirculation; Microcirculatory image quality; Sidestream dark field imaging