Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study

E Christiaan Boerma¹^,2 , Keshen R Mathura¹ , Peter HJ van der Voort² , Peter E Spronk¹^,3 and Can Ince¹

¹Department of Physiology, Academic Medical Centre, University of Amsterdam, The Netherlands

²Department of Intensive Care, Medical Centre Leeuwarden, The Netherlands

³Department of Intensive Care, Gelre Ziekenhuizen Apeldoorn, The Netherlands

author email corresponding author email

Critical Care 2005, 9:R601-R606doi:10.1186/cc3809


Published:	22 September 2005

Abstract

Introduction

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.

Conclusion

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.