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The OxyCam:A novel hand-held vital microscope for quantitative measurement of microcirculatory perfusion and oxygenation 认领 引用
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作者 Can Ince Bülent Ergin +9 位作者 Jonathan Montomoli Mario Döring Noor Boegborn Wijnie van Dam Giovanny Marchena Olcay Dilken Arie de Vos Husain Khaki Diederik Gommers Matthias Peter Hilty 《Journal of Intensive Medicine》 CSCD 2026年第4期382-390,共9页
Background:Hand-Held Vital Microscopy(HVM)has been utilized in clinical investigations to measure micro-circulation,providing valuable insights into the pathophysiology of critical illness and its treatment.However,it... Background:Hand-Held Vital Microscopy(HVM)has been utilized in clinical investigations to measure micro-circulation,providing valuable insights into the pathophysiology of critical illness and its treatment.However,its clinical implementation has been hampered by several shortcomings.These included the need for automatic analysis software,for instant image stabilization,and for information regarding microcirculatory oxygenation.The aim of this study is to describe an HVM which has realized these research objectives.Methods:This preclinical study introduces the OxyCam,a novel HVM device.OxyCam stabilizes images dur-ing recording and subsequently provides essential microcirculatory functional parameters through automatic analysis.Green and blue illuminated images,sequentially recorded and ratio imaged,allow calculation of the hemoglobin(Hb)oxygen saturation(μHbO2sat)of RBCs and are presented in pseudo color images.We validated the OxyCam on the hindlimb muscle of 9 male Wistar albino rats,mechanically ventilated at different levels of inspired oxygen(FiO2).Comparison was made between OxyCam-green and blue images and to its predecessor the Cytocam.OxyCam-generated μHbO2sat values were compared to HbO2sat fiber spectrophotometry(O2C).Results:Green and blue illumination from the OxyCam yielded higher total vessel density(OxyCam green[31.4±4.3]mm/mm2;OxyCam blue[32.5±4.2]mm/mm2,Cytocam[28.5±3.6]mm/mm2)and functional capil-lary density(OxyCam green[25.4±6.4]mm/mm2;OxyCam blue[26.2±7.9]mm/mm2;Cytocam[23.0±4.5]mm/mm2)than the Cytocam images OxyCam-blue gave higher tissue RBC perfusion values(OxyCam green[55.3±18.0]μm/min;OxyCam blue[69.5±25.5]μm/min;Cytocam[58.3±15.3]μm/min)than the OxyCam-green or Cytocam images.OxyCam-blue and green images gave better image quality than the Cytocam images.μHbO2sat imaging with the OxyCam was validated by demonstrating expected changes in μHbsat during differ-ent FiO2levels(100%,60%,21%,0%).Furthermore,a correlation between the mean μHbO2sat of images and independently measured μHbsat by tissue spectrophotometry during different levels of FiO2was found.Finally,μHbO2sat images in pseudo-color(red to blue)are shown for the individual microvessels at different FiO2levels.Conclusions:The OxyCam has been validated for measuring tissue perfusion and oxygenation and can be consid-ered for point-of-care diagnosis of the microcirculation at the bedside. 展开更多
关键词 OxyCam Cytocam Sublingual Spectrophotometry Tissue oxygenation Tissue perfusion
Microcirculatory response and leukocyte activation in patients undergoing elective cardiac surgery with cardiopulmonary bypass 认领 引用
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作者 Emanuele Favaron Can Ince +4 位作者 Ruben J.Bosch Veronika Evers Matthias P.Hilty Jonathan Montomoli Wim Jan van Boven 《Journal of Intensive Medicine》 CSCD 2026年第3期302-309,共8页
Background:Fluid administration,priming solutions,and the use of cardiopulmonary bypass(CPB)during cardiac surgery are likely to promote hemodilution and inflammatory responses,leading to microcirculatory impairment.A... Background:Fluid administration,priming solutions,and the use of cardiopulmonary bypass(CPB)during cardiac surgery are likely to promote hemodilution and inflammatory responses,leading to microcirculatory impairment.A new integrative investigation of microcirculatory hemodynamics,leukocyte activation,and extracellular water can reveal these alterations in patients throughout the perioperative phase of cardiac surgery.Methods:This single-center observational study included consecutive patients undergoing elective open cardiac surgery with CPB at the Amsterdam University Medical Centers(location AMC),Netherlands,between December 2019 and March 2021.Sublingual microcirculation was assessed using incident dark-field imaging in 17 patients who underwent elective open cardiac surgery at seven different time points:at hospital admission(T0),after induction of anesthesia(T1),10 min after induction of cardio-pulmonary bypass(T2),after removal of aortic clamp(T3),at the end of surgery(T4),on the day of discharge from intensive care unit(ICU)(T5),and on day 3 after ICU discharge(T6).Automated and manual analyses were performed to analyze microcirculatory hemodynamics and leukocyte activation,respectively.Non-invasive pulse contour assessment of cardiac output and body fluid composition was also included.Generalized mixed-effects models were used for statistical analysis.Results:During surgery,in line with macro-hemodynamics,the oxygen transport capability at the tissue level was impaired,as observed by a significant decrease in tissue red blood cell perfusion compared with the preoperative baseline([53.4±17.5]vs.[36.1±10.5]μm/min,P<0.001).In the postoperative phase,the microcirculation recovered to baseline levels([54.6±12.5]μm/min).However,inflammation,indicated by an increased number of leukocytes at the microcirculatory level compared to baseline([8.7±3.4]vs.[23.9±5.9]/4 s,P<0.001),began early during surgery and showed incomplete resolution by the last postoperative measurement([16.4±3.9]/4 s),paired with elevated plasma leukocytes,overhydration observed through bioimpedance,and weight gain.Conclusion:Integrative monitoring of the microcirculation,hemodynamics,and body composition of patients who underwent CPB revealed a temporal association between tissue perfusion and hemodynamic changes during cardiac surgery and between leukocyte activation and fluid accumulation. 展开更多
关键词 Microcirculation Tissue perfusion Leukocyte activation Cardiac surgery Cardiopulmonary bypass Fluid accumulation
Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients 认领 引用 被引量：2
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作者 Olcay Dilken Annemieke Dijkstra +6 位作者 Goksel Given Bülent Ergin Nicole Trommel Margriet E.van Baar Helma WC Hofland Can Ince Cornelis H.van der Vlies 《Journal of Intensive Medicine》 CSCD 2025年第1期58-63,共6页
Background:Severe burns induce volume shifts via capillary leaks,eventually requiring massive fluid resuscitation and promoting tissue edema.Albumin may help to mitigate the edema,thereby improving perfusion.This stud... Background:Severe burns induce volume shifts via capillary leaks,eventually requiring massive fluid resuscitation and promoting tissue edema.Albumin may help to mitigate the edema,thereby improving perfusion.This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema.Methods:This prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center,Rotterdam,The Netherlands.Patients with severe burns affecting>15%of the total body surface area were included.Fluid management was conducted in accordance with the Parkland formula.Albumin(20%)was administered at a rate of 0.5 mL/(kg·h),starting 12 h after the burn incident.Alterations in the sublingual microcirculation,including capillary perfusion and density,were measured at admission(T0)and 4 h(T4)and 12 h(T12)after admission.Sublingual depth of focus(DOF)of the microcirculation was used to quantify the tissue edema.Results:Nine patients were recruited with a mean total body surface area of 36%±23%.By T12,a median of 4085 mL(interquartile range[IQR]:3714-6756 mL)of crystalloids and 446 mL(IQR:176-700 mL)of 20%albumin were administered.The DOF increased significantly after crystalloid administration(T4 vs.T0,mean difference[MD]=27.4μm,95%confidence interval[CI]:3.4 to 50.9,P=0.040).Following albumin administration,DOF significantly decreased(T12 vs.T4,MD=-76.4μm,95%CI:-116.6 to-36.1,P=0.002).Total vessel density decreased significantly with crystalloid administration(T4 vs.T0,MD=-3.5 mm/mm2,95%CI:-5.7 to-1.4,P=0.004)but increased after albumin administration(T12 vs.T4,MD=6.2 mm/mm2,95%CI:3.2 to 9.3,P=0.001).Conclusion:Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns.Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema. 展开更多
关键词 Shock Crystalloid solutions Albumins Burns Microcirculation
Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock 认领 引用 被引量：6
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作者 Huai-Wu He Yun Long +1 位作者 Da-Wei Liu Can Ince 《Chinese Medical Journal》 SCIE CAS CSCD 2019年第10期1218-1227,共10页
Objective:Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation(Macro).This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulato... Objective:Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation(Macro).This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock.Data sources:We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations,including resuscitation,circulatory shock,septic shock,tissue perfusion,hemodynamic coherence,and microcirculation(Micro).Study selection:The data from peer-reviewed journals printed in English on the relationships of tissue perfusion,shock,and resuscitation were included.Results:A binary(coherence/incoherence,coupled/uncoupled,or associated/disassociated)mode is used to describe resuscitation coherence.The phenomenon of resuscitation incoherence(RI)has gained great attention.However,the RI concept requires a more practical,systematic,and comprehensive framework for use in clinical practice.Moreover,we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro,Micro,and cell.The RI is divided into four types(Type 1:Macro-Micro incoherence+impaired cell;Type 2:Macro-Micro incoherence+normal cell;Type 3:Micro-Cell incoherence+normal Micro;and Type 4:both Macro-Micro and Micro-cell incoherence).Furthermore,we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock.Conclusions:The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock.Moreover,these concepts require further studies in clinical practice. 展开更多
关键词 Circulatory shock Shock Tissue perfusion Microcirculation Hemodynamic coherence Resuscitation incoherence
Machine learning using the extreme gradient boosting(XGBoost)algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients 认领 引用 被引量：2
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作者 Jonathan Montomoli Luca Romeo +14 位作者 Sara Moccia Michele Bernardini Lucia Migliorelli Daniele Berardini Abele Donati Andrea Carsetti Maria Grazia Bocci Pedro David Wendel Garcia Thierry Fumeaux Philippe Guerci Reto Andreas Schüpbach Can Ince Emanuele Frontoni Matthias Peter Hilty RISC-19-ICU Investigators 《Journal of Intensive Medicine》 2021年第2期110-116,共7页
Background:Accurate risk stratification of critically ill patients with coronavirus disease 2019(COVID-19)is essential for optimizing resource allocation,delivering targeted interventions,and maximizing patient surviv... Background:Accurate risk stratification of critically ill patients with coronavirus disease 2019(COVID-19)is essential for optimizing resource allocation,delivering targeted interventions,and maximizing patient survival probability.Machine learning(ML)techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care.Methods:We retrieved data on patients with COVID-19 admitted to an intensive care unit(ICU)between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit(RISC-19-ICU)registry.We applied the Extreme Gradient Boosting(XGBoost)algorithm to the data to predict as a binary out-come the increase or decrease in patients’Sequential Organ Failure Assessment(SOFA)score on day 5 after ICU admission.The model was iteratively cross-validated in different subsets of the study cohort.Results:The final study population consisted of 675 patients.The XGBoost model correctly predicted a decrease in SOFA score in 320/385(83%)critically ill COVID-19 patients,and an increase in the score in 210/290(72%)patients.The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model(0.86 vs.0.69,P<0.01[paired t-test with 95%confidence interval]).Conclusions:The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems(CDSSs)aimed at optimizing available resources. 展开更多
关键词 Machine learning Extreme gradient boosting(XGBoost) COVID-19 Multiple organ failure Clinical decision support system(CDSS) Organ dysfunction score
Interpatient heterogeneity in hepatic microvascular blood flow during vascular inflow occlusion (Pringle manoeuvre) 认领 引用 被引量：6
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作者 Lucinda Shen Zühre Uz +4 位作者 Joanne Verheij Denise P.Veelo Yasin Ince Can Ince Thomas M.van Gulik 《Hepatobiliary Surgery and Nutrition》 SCIE 2020年第3期271-283,共13页
Background:Vascular inflow occlusion(VIO)during liver resections(Pringle manoeuvre)can be applied to reduce blood loss,however may at the same time,give rise to ischemia-reperfusion injury(IRI).The aim of this study w... Background:Vascular inflow occlusion(VIO)during liver resections(Pringle manoeuvre)can be applied to reduce blood loss,however may at the same time,give rise to ischemia-reperfusion injury(IRI).The aim of this study was to assess the characteristics of hepatic microvascular perfusion during VIO in patients undergoing major liver resection.Methods:Assessment of hepatic microcirculation was performed using a handheld vital microscope(HVM)at the beginning of surgery,end of VIO(20 minutes)and during reperfusion after the termination of VIO.The microcirculatory parameters assessed were:functional capillary density(FCD),microvascular flow index(MFI)and sinusoidal diameter(SinD).Results:A total of 15 patients underwent VIO;8 patients showed hepatic microvascular perfusion despite VIO(partial responders)and 7 patients showed complete cessation of hepatic microvascular perfusion(full responders).Functional microvascular parameters and blood flow levels were significantly higher in the partial responders when compared to the full responders during VIO(FCD:0.84±0.88 vs.0.00±0.00 mm/mm2,P<0.03,respectively,and MFI:0.69–0.22 vs.0.00±0.00,P<0.01,respectively).Conclusions:An interpatient heterogeneous response in hepatic microvascular blood flow was observed upon VIO.This may explain why clinical strategies to protect the liver against IRI lacked consistency. 展开更多
关键词 Liver perfusion microcirculation
Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery 认领 引用 被引量：2
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作者 Arthur LM Tavy Anton FJ de Bruin +5 位作者 E Christiaan Boerma Can Ince Matthias P Hilty Peter G Noordzij Djamila Boerma Mat van Iterson 《Journal of Intensive Medicine》 2021年第1期59-64,共6页
Background:In clinical practice,blood pressure is used as a resuscitation goal on a daily basis,with the aim of maintaining adequate perfusion and oxygen delivery to target organs.Compromised perfusion is often indica... Background:In clinical practice,blood pressure is used as a resuscitation goal on a daily basis,with the aim of maintaining adequate perfusion and oxygen delivery to target organs.Compromised perfusion is often indicated as a key factor in the pathophysiology of anastomotic leakage.This study was aimed at assessing the extent to which the microcirculation of the bowel coheres with blood pressure during abdominal surgery.Methods:We performed a prospective and observational cohort study.In patients undergoing abdominal surgery,the serosal microcirculation of either the small intestine or the colon was visualized using handheld vital mi-croscopy(HVM).From the acquired HVM image sequences,red blood cell velocity(RBCv)and total vessel density(TVD)were calculated using MicroTools and AVA software,respectively.The association between microcircula-tory parameters and blood pressure was assessed using Pearson’s correlation analysis.We considered a two-sided P-value of<0.050 to be significant.Results:In 28 patients undergoing abdominal surgery,a total of 76 HVM images were analyzed.The RBCv was 335±96μm/s and the TVD was 13.7±3.4 mm/mm 2.Mean arterial pressure(MAP)was 71±12 mm Hg during microcirculatory imaging.MAP was not correlated with RBCv(Pearson’s r=−0.049,P=0.800)or TVD(Pearson’s r=0.310,P=0.110).Conclusion:In 28 patients undergoing abdominal surgery,we found no association between serosal intestinal microcirculatory parameters and blood pressure. 展开更多
关键词 Intestinal microcirculation Handheld vital microscopy Abdominal surgery Hemodynamic management
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