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Technical article

The Sidestream Dark Field (SDF) Handheld Imaging Device


Microcirculation Microscope


Mesentery microcirculation

HD-WX-10 Multi-location Microcirculation Microscope


HD-WX-10 Microcirculation Machine


Mouse Auricle Microcirculation Observation System


Handheld Color Microcirculation Analyzer


Imaging of the sublingual microcirculation in elderly patients ¨C a pilot study


Sublingual microcirculation


Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill......


Microcirculation


Applications of Real-time Polarization Difference Imaging in Healthcare


Bench-to-bedside review: Mechanisms of critical illness......


SUBLINGUAL MICROCIRCULATION OF ....


Observation of the prevalence of sublingual.....


Non-invasive assessment of microcirculation by sidestream dark field imaging......


Imaging of the intestinal microcirculation


Improvement of Sidestream Dark Field Imaging with ......


Intraoperative imaging of the brain macro- and microcirculation......


Orthogonal Polarization Spectral (OPS)/Sidestream dark field (SDF) imaging.......


SIDESTREAM DARK FIELD IMAGING: A NOVEL ......


Sidestream dark-field imaging and image analysis......


Experimental studies


Sepsis and septic shock


Effect of various interventions


Heart failure and cardiogenic shock


Renovascular disease, microcirculation, and the progression of renal injury......
ATP, P2 receptors and the renal microcirculation
Changes in Cerebral Microcirculation During......
Influence of Platelet-Activating Factor on Cerebral Microcirculation in Rats
Self-mixing Microprobe For monitoring Microvascular Perfusion In Rat Brain
 Microcirculation after cerebral venous occlusions as assessed by laser Doppler scanning
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Microcirculation Microscope

1.Video Enlargement:(14'Monitor) 200X  2.Chromatic aberration diminishing object lens :4X

3.Vertical Adjustment distance:20mm¡­¡­MORE

Mesentery microcirculation

XSX-1 Animal Mesentery Microcirculation constant temperature and humiditySystem¡­¡­MORE

HD-WX-10 Multi-location Microcirculation Microscope

Multi-location Microcirculation Microscope (Can not be continuously adjustable magnifying power)¡­¡­MORE

HD-WX-10 Microcirculation Machine

Color micro-circulation microscope with coaxially conjugated hand wheel for focus adjustment and  transverse/longitudinal moving plane table¡­¡­MORE

Mouse Auricle Microcirculation Observation System

Mouse(chmice£¬Mice )Auricle (ear ) Microcirculation Observation System¡­¡­MORE

Handheld Color Microcirculation Analyzer

1. Fast and easy operation to detect microcirculation in less than 5s    2. Stable and clear imaging¡­¡­MORE

Experimental studies

The sublingual microcirculation and its changes have been studied during various experimental settings, mostly in animal mod¬els of sepsis and shock......MORE


Sublingual microcirculation

Microcirculation plays a crucial role in the interaction between blood and tissue both in physiolog¬ical and pathophysiological states. Orthogonal polarization spectral (OPS) and Side stream dark field (SDF) imaging.......MORE


Imaging of the sublingual microcirculation in elderly patients ¨C a pilot study

Demographic changes, i. e. worldwide increase in older population, require to direct research ef¬forts to age-relevant topics. The present article focuses on microcirculation in elderly patients. Sidestream dark field (SDF) imaging(visualize the microcirculation at the bedside,Cerebral microcirculation,Brain microcirculation,Renal microcirculation,Kidney microcirculation,Sublingual microcirculation)......MORE

Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill - where do we stand?

patients is to restore microcirculatory perfusion and tissue oxygenation to prevent organ hypoxia and main¬tain organ function [1-3]. It has been recognized thattherapeutic interventions should be delivered as early aspossible [3,4] and early protocol-driven ......MORE

Microcirculation

The microcirculation is the part of the circulation whereoxy¬gen,nutrients, hormones,and waste products are exchanged between circulating blood and parenchymal cells. The micro¬circulation includes not only all the vessels with a diameter <100 µm but also the interactions between......MORE


Applications of Real-time Polarization Difference Imaging in Healthcare

Polarimetry is a well-established tool for non-invasive material characterization and involves comparison of the polarization states of light before and after the light interacts with the material. The use of ......MORE


Bench-to-bedside review: Mechanisms of critical illness ¨C classifying microcirculatory flow abnormalities in distributive shock

Bottom Line: In this paper, we classify the different types of heterogeneous flow patterns of microcirculatory abnormalities found during different types of distributive shock.Analysis of these patterns gave a five class classification system to define the types of microcirculatory ......MORE


SUBLINGUAL MICROCIRCULATION OF PREGNANT AND NON-PREGNANT WOMEN

Introduction: Microcirculation, the small vessels in the vasculature, embedded within organs, is responsible for the distribution of blood within tissues, regulation of blood pressure, delivery of oxygen and other nutrients. Sidestream Dark Field (SDF) imaging is a .....MORE

Observation of the prevalence of sublingual microcirculatory alterations with SDF imaging in intensive care patients

The microcirculation is the part of the vascular system that consists of arterioles, capillaries and venules. It plays a pivotal role in tissue oxygen delivery (1). Microcirculatory dysfunction can......MORE


Non-invasive assessment of microcirculation by sidestream dark field imaging as a marker of coronary artery disease in diabetes

Purpose: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to ......MORE


Imaging of the intestinal microcirculation

Microcirculatory dysfunction is important in different intestinal pathologies. Therefore, it is essen¬tial for adequate therapeutic strategies to be based on reliable microcirculatory diagnostics......MORE


Improvement of Sidestream Dark Field Imaging with an Image Acquisition Stabilizer

Background: In the present study we developed, evaluated in volunteers, and clinically validated an image
acquisition stabilizer (IAS) for Sidestream Dark Field (SDF) imaging. Methods: The IAS is a stainless steel......
MORE


Intraoperative imaging of the brain macro- and microcirculation

Advances in imaging technology have provided new diagnostic methods for assessment of cerebral vascular perfusion and quantitative analysis of the microcirculation during cerebral surgery. ......MORE


Orthogonal Polarization Spectral (OPS)/Sidestream dark field (SDF) imaging: a new method for the observation of the microcirculation in pediatrics

Microcirculation plays an important role both in physiological and pathophysiological states. Early recognition of changes in microcirculation is crucial for starting early therapeutic ......MORE


SIDESTREAM DARK FIELD IMAGING: A NOVEL MICROSCOPIC MODALITY FOR CLINICAL ASSESSMENT OF THE MICROCIRCULATION

The introduction of Orthogonal Polarization Spectral (OPS) imaging and its implementation into a clinically-applicable hand-held microscope opened the field of studying the human microcirculation in ......MORE


Sidestream dark-field imaging and image analysis of oral microcirculation under clinical conditions

Tissue dysoxia and microcirculatory dysfunction are generally regarded as the primary culprits of organ failure and inadequate wound healing in critically ......MORE


Sepsis and septic shock

In the last few years, an important body of knowledge has been developed showing the pathophysiological relevance of the......MORE


Effect of various interventions

Fluids, vasopressors/inotropes during sepsis and organ support techniques are (together with the control of infection source) ......MORE


Heart failure and cardiogenic shock

Microcirculatory alterations are present in patients with severe heart failure. De Backer evaluated sublingual microcirculation(Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))......MORE


Renovascular disease, microcirculation, and the progression of renal injury: role of angiogenesis

Emerging evidence supports the pivotal role of renal microvascular(Renal microcirculation,kidney microcirculation) disease as a......MORE

ATP, P2 receptors and the renal microcirculation

Purinoceptors are rapidly becoming recognised as important regulators of tissue and organ function. Renal (Renal microcirculation,kidney microcirculation)expression......MORE

Changes in Cerebral Microcirculation During and After Abdominal Aortic Cross-Clamping in Rabbits: The Role of Thromboxane A2 Receptor

Little is known about any changes in cerebral hemodynamics(Cerebral microcirculation, brain microcirculation),during and after......MORE

Influence of Platelet-Activating Factor on Cerebral Microcirculation in Rats

Background and Purpose¡ªPlatelet-activating factor (PAF) is involved in the development of secondary brain (Cerebral microcirculation, brain microcirculation)damage ......MORE

Self-mixing Microprobe For monitoring Microvascular Perfusion In Rat Brain

Abstract   Measuring functional activity in brain in connection with neural stimulation faces technological challenges. Our goal is to evaluate, in relative terms, ......MORE

Microcirculation after cerebral venous occlusions as assessed by laser Doppler scanning

Reombotic technique provides a minimally invasive, clinically relevant, and reproducible model suited to study the pathophysiology of CVCDs. I  ......MORE

Experimental studies
The sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))and its changes have been studied during various experimental settings, mostly in animal mod¬els of sepsis and shock (7). Verdant deter¬mined the relationship between sublingual and intestinal mucosal microcirculatory(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) per¬fusion and his findings support the sublin¬gual region as an appropriate region to mon¬itor the microcirculation in sepsis (45). On the model of endotoxemia in sheep, sublin¬gual microvascular flow indexes were re¬duced, fluid resuscitation corrected both serosal intestinal and sublingual microcirculation(Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) but was unable to restore intestinal mucosal perfusion (46). Effects of the selec¬tive iNOS inhibitor with those of norepi¬nephrine (NE) on sublingual microcirculation was studied in a sheep model of septic shock, selective iNOS inhibition had more beneficial effects than NE on microcircula¬tion assessed by SDF imaging sublingually(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) (47). The use of enalaprilat prevented the worsening of sublingual microcirculatory variables in fluid-resuscitated, hyperdynamic model of septic shock (48). Alterations of sublingual microcirculation are present also during experimental haemorrhagic shock
and these alterations arise from the first step of the bleeding (49), restoration of microcir¬culatory flow may be achieved by gelatine and hydroxyethyl starch (50). During cardiac arrest in pigs, sublingual microcirculatory blood flow was highly correlated with macrocirculatory hemodynamics. Adminis¬tration of epinephrine dramatically de¬creased microcirculatory blood flow (51). Microvascular blood flow in the sublingual mucosa is also closely related to coronary perfusion pressure during cardiopulmonary resuscitation and predictive of outcome (52). During hypodynamic state of experimental sepsis after infusion of E. coli time-depend¬ent strong correlation exists between sublin¬gual and other microvascular beds, neverthe¬less, the sublingual mucosa exhibited the most pronounced alterations of microcircula¬tory flow in comparison with conjunctival, jejunal, and rectal microvasculature (53). Al¬teration of sublingual microvascular re¬sponse was also detected during experimen¬tal mild hypothermia in an ovine model, where there was a significant decrease in the proportion and density of small perfused ves¬sels, all microcirculatory variables returned to baseline levels during the re-warming phase (54).
Clinical studies
Not surprisingly, probably due to the fact that technology of OPS-SDF imaging (sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) has been in¬corporated into a small hand-held video-mi¬croscope, which can be used in clinical set¬ting, much more studies on sublingual microcirculation are in humans, particularly in area of critically ill patients. A growing body of ev¬idence exists on disturbed sublingual micro¬circulatory functions in relation to increased morbidity and mortality in a wide array of clinical scenarios (12, 13). Changes of sublin¬gual microcirculatory parameters (total and perfused small vessel density) have been re¬cently proposed as an early predictor for crit¬ically ill patients (55, 56) and there are sever¬al areas in human medicine, where observa¬ tion of sublingual microcirculatory bed has been carried out ¨C sepsis, shock, cardiac ar¬rest, effect of various treatments and extreme physiological conditions.
Sepsis and septic shock
In the last few years, an important body of knowledge has been developed showing the pathophysiological relevance of the sublin¬gual microcirculation in the development of multi organ failure associated with sepsis. In addition to the compelling experimental evi¬dence, the development of new videomicro¬scopic techniques allows now the evaluation of the microcirculation in critically ill pa¬tients. Consequently, the sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))can be easily monitored at bed¬side. Therefore, studies performed in the sublingual area show that severe microcircu¬latory sublingual alterations are present in septic patients (5). Sepsis results in derange¬ments of microvascular flow, which can be identified in the early stages of this disease. These abnormalities are more marked in the most severely ill patients (57), those changes are present during early course of infection even in preterm infants (3). Sepsis mortality is closely linked to multi-organ failure; im¬paired microcirculatory blood flow is thought to be a key point in the pathogene¬sis of sepsis-induced organ failure (58). Im¬ages of the sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))dur¬ing septic shock and resuscitation have re¬vealed that the distributive defect of blood flow occurs at the capillary level. Boerma validated intra-observer and inter-observer reproducibility of OPS images analysis for sublingual bed and concluded that semi¬quantitative analysis of sublingual microcir¬culatory flow provides a reproducible and transparent tool in clinical research to moni¬tor and evaluate the microcirculation during sepsis (4). De Backer and coworkers investi¬gated sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) in 50 pa¬tients with sepsis by using OPS technique; the density of all vessels was significantly re¬duced in patients with severe sepsis (4.5 [4.2-5.2] versus 5.4 [5.4-6.3]/mm in volun¬teers, p < 0.01). The proportion of perfused small (< 20 um) vessels was reduced in pa¬tients with sepsis (48 [33-61] versus 90 [89¬92]% in volunteers, p < 0.001), these alter¬ations were more severe in nonsurvivors and they concluded that microvascular blood flow alterations are frequent in patients with sepsis and are more severe even in patients with a worse outcome (44). The sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))was investigated by using OPS in patients with sepsis and organ failure in order to characterize the time course of microcirculatory dysfunction and relation to clinical outcome. Small vessel perfusion im¬proved over time in survivors (p<0.05 be¬tween survivors and nonsurvivors) but not in nonsurvivors. Despite similar hemodynamic and oxygenation profiles and use of vaso¬pressors at the end of shock, patients dying after the resolution of shock in multiple or¬gan failure had a lower percentage of per¬fused small vessels than survivors (57.4 [46.6-64.9] vs. 79.3 [67.2-83.2]%; p =. 02) (59). Changes in microcirculation occurred at an early stage in all patients with severe sepsis/septic shock treated with early goal-di¬rected therapy, sublingual perfusion indices were more markedly impaired in nonsur¬vivors compared with survivors (57, 60). In¬terestingly, sublingual microvascular de¬rangements in septic shock did not differ be¬tween noncytopenic and cytopenic patients (61). Haemodynamic monitoring of septic patients is often impeded by the discrepancy between the macrocirculation and microcir¬culations parameters, however some correla¬tion between systemic hemodynamic param¬eters and microcirculation may exist, as shown in a study comparing pulse contour analysis (PiCCO) variables and sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))perfusion indices, where significant correlations were found for cur¬rent velocity in small venules with systemic vascular resistance (r(2) = 0.252, p < 0.05) and mean arterial blood pressure (r(2) = 0.259, p < 0.05), in addition, a significant correlation was also found between the oxy¬gen transport index and the density of small vessels in sublingual area (r(2) = 0.355; p < 0.05) (62). Recent papers also reveal correla¬tion between lactate level and degree of sub¬lingual microcirculation impairment. In 31 surgical patients significant correlation be¬tween the total small vessel density at 1 h and the blood lactate level at 24 h was found (55). During septic shock, increased lactate may play an important role in terms of wors¬ening microcirculatory abnormalities, pa¬tients without hyperlactatemia presented higher proportion of perfused vessel and mi¬crovascular flow index (63). Changes in sub¬lingual microcirculation during sepsis were identified also in children and infants (3, 64). To summarize, the main characteristics of sublingual microcirculation(Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))in patients with septic shock are hypoperfusion and in¬creased flow heterogeneity and nonsurvivors showed more severe alterations than sur¬vivors (65).
Effect of various interventions
Fluids, vasopressors/inotropes during sepsis and organ support techniques are (together with the control of infection source) key ele¬ments of treatment in all patients with severe sepsis and septic shock. Each of these com¬ponents were extensively studied with re¬gard to their effect on microcirculation dur¬ing past years, however mainly in experi¬mental setting and unfortunately only few human studies have been published so far. Early protocol directed resuscitation (includ¬ing fluid administration) was associated with reduced organ failure at 24 h and results sup¬port the hypothesis that targeting the micro¬circulation distinct from the macrocircula¬tion could potentially improve organ failure in sepsis (60). There is ongoing discussion re¬garding target blood pressure in patients with septic shock (66), increasing MAP above 65 mmHg with norepineprhrine was associated with improved microvascular function, on the other side, the microvascular response may vary among patients suggesting that in¬dividualization of blood pressure targets may be warranted (67). Effect of fluid administra¬tion on microcirculatory alterations was eval¬uated in 60 patients with severe sepsis, where fluid administration increased signifi¬cantly perfused small vessel density, impor¬tantly, microvascular perfusion increased in the early but not in the late phase of sepsis and microvascular effects of fluids were not related to changes in cardiac index or mean arterial pressure (68). Dubin compared 6% hydroxyethyl starch (HES) 130/0.4 with nor¬mal saline for resuscitation during early goal¬directed therapy (EGDT) in 20 septic patients by using SDF(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)), sublingual capillary density was similar in both groups, but capillary mi¬crovascular flow index, percent of perfused capillaries, and perfused capillary density were higher in 6% HES (69). The use of hy¬pertonic fluids in patients with septic shock did not improve sublingual microcirculatory blood flow in comparison to isotonic fluid (70). Improvement of microcirculation in pa¬tients with severe sepsis may be achieved, however, even by passive leg rising aiming to increase intravascular volume (71). Using vasopressors to maintain blood pressure has been an important part of septic shock, ac¬cording to experimental results, their use may compromise microcirculatory flow in different areas. To investigate the effect of norepinephrine (NE) on sublingual microvas¬cular flow (SDF)(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) in patients with septic shock, increasing dose of NE was adminis¬tered to achieve MAP from 60 to 70-90 mm Hg. No changes in sublingual microvascular flow index, vessel density, the proportion of perfused vessels, perfused vessel density, or heterogeneity index were identified during NE infusion (72). Similar study was carried out in 20 septic shock patients where at a MAP of 65 mmHg, norepinephrine was titrated to reach a MAP of 75 mmHg, and then to 85 mmHg, sublingual microcirculation was assessed by SDF imaging(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)). All pa¬tients showed severe sublingual microcircu¬latory alterations failed to improve with the increases in MAP with norepinephrine (69). Adding terlipressin or arginine vasopressin to norepineprhrine (NE) in patients with NE de¬pendent septic shock does not affect sublin¬gual microcirculatory flow (73). Dobutamin is recommended as an inotropic agent ac¬cording to Surviving Sepsis Campaign Guidelines. De Backer evaluated effect of dobutamine on microcirculatory alterations in 22 patients with septic shock, dosage of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock and these changes are in¬dependent of changes in systemic hemody¬namic variables (74). Compared to dobuta¬mine, levosimendan improved sublingual microcirculatory blood flow in patients with septic shock, as reflected by changes in mi¬crocirculatory flow indices of small and medium vessels (75) Dobutamine, however prevented postoperative decrease of sublin¬gual microvascular blood flow in patients af¬ter esophagectomy (76). The administration of hydrocortisone in septic shock results in a modest but consistent improvement in sub¬lingual capillary perfusion (77). Transfusion as a part of EGDT protocols and Surviving Sepsis Campaign Guidelines was also evaluated in terms of its effect on mi¬crocirculation in patients with sepsis and sep¬tic shock. An effect of red blood cell transfu¬sion on sublingual microvascular perfusion was studied in 35 patients with sepsis before and 1 hour after transfusion by using OPS im¬aging. Microvascular perfusion was not sig¬nificantly altered by transfusion, but there was considerable interindividual variation. The change in capillary perfusion after trans¬fusion correlated with baseline capillary per¬fusion and red blood cell storage time had no influence on the microvascular response to red blood cell transfusion (78-81). Effect of transfusion on microcirculation probably also depends on baseline microcirculatory status, patients with relatively altered baseline vari¬ables (proportion of perfused vessel) tend to demonstrate improvement in perfusion fol¬lowing transfusion, whereas those with rela¬tively normal perfusion at baseline tend to demonstrate either no change or, in fact, a decline in this parameter (82). Mechanical ventilation and PEEP have no general delete¬rious effects on microvascular perfusion of the sublingual mucosa (83).
Heart failure and cardiogenic shock
Microcirculatory alterations are present in patients with severe heart failure. De Backer evaluated sublingual microcirculation(Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) in in 40 patients with acute severe heart failure, including 31 patients with cardiogenic shock, by using OPS and found the propor¬tion of perfused small (<20 um) vessels was lower in patients with cardiac failure and car¬diogenic shock than in control patients (63% [46%-65%] and 49% [38%-64%] vs. 92% [90%-93%], P <.001). The proportion of perfused vessels was higher in patients who survived than in patients who did not survive in all vessels (90% [84%-93%] vs. 81% [74%-87%], P <.05) and in small vessels (64% [49%-68%] vs. 43% [37%-62%], P <.05) (84). Similar results were found in Jung¡¯s study evaluating 24 critically ill pa¬tients admitted to ICU. Seven patients with cardiogenic shock had lower microflow compared with patients without cardiogenic shock (small p<0.001, medium p<0.001, large p=0.003). Several other diseases, in¬cluding diabetes and arterial hypertension, age, gender, had no influence on microcircu¬latory parameters (85). Recent paper by El¬bers revealed also microcirculatory abnor¬malities during atrial fibrillation and succes¬full electrical cardioversion improved in¬dices of sublingual microvascular perfusion (86), similarly as with cardiac resynchroniza¬tion (87). To summarize the key findings of sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))during severe heart failure and cardiogenic shock ¨C there is reduced vascular density and impaired mi¬croflow, especially in the smallest vessels (88). Vasopressors, inotropes and intra-aortic balloon pump represent most often thera¬peutic approaches in patients with severe heart failure and cardiogenic shock. Several studies examined effect of those common in¬terventions with regard to sublingual micro¬circulation. The first paper evaluating effects of vasopressor therapy on sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))by using OPS was a case report in patients with severe distributive and cardio¬genic shock following cardiac surgery, where vasopressin was used, however de¬spite its strong vasopressor effects vaso¬pressin infusion did not worsen microcircu¬latory alterations in this patient (89). Effect of nitroglycerine was tested in 17 patients with cardiogenic shock and chronic heart failure. Nitro-glycerine dose-dependently increases tissue perfusion in patients with severe heart failure, as observed by an increase in sublin¬gual perfused capillary density (90). Similar findings were found during intravenous infu¬sion at a fixed dose of nitroglycerine (NTG) 33 microg/min in 20 acute heart failure pa¬tients, where even low-dose NTG significant¬ly improved sublingual microvascular perfu¬sion (91). Effect of intra-aortic balloon pump support (IABP) on macrocirculation and sublingual microcirculation (SDF) (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))in patients with cardiogenic shock was studied by Uil, 13 patients were treated with IABP at differ¬ent assist ratios. Discontinuation of IABP de¬creased the mean arterial pressure and car¬diac index; however, these changes in macrohemodynamics did not significantly influence sublingual perfused capillary den¬sity and capillary red blood cell velocity (92). Improved sublingual microcirculatory flow after IABP was described by Jung in 13 pa¬tients with cardiogenic shock (93), combin¬ing IABP with extracorporeal membrane oxy¬genation has led in patient with severe re¬fractory cardiogenic shock to further im¬provement of sublingual microcirculatory flow assessed by SDF imaging(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) (94). Interest¬ingly recent paper by Munsterman describes discontinuing IABP support showed (SDF)(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) an increase of microcirculatory flow of small vessels after ceasing IABP therapy and his observation may indicate that IABP impairs microvascular perfusion in recovered pa¬tients (95). Sublingual microcirculation was assessed also during CPR, first report of using SDF imaging(sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) during chest compressions re¬vealed persisting capillary flow even during CPR interruption. Indices of microvascular perfusion were low and were relatively inde¬pendent from blood pressure (96). In cardio¬surgery, the use of pulsatile cardiopulmonary bypass (CPB) preserves microcirculatory per¬fusion throughout the early postoperative pe¬riod, irrespective of systemic hemodynamics (97), also changes in CPB flow rate within 20% did not alter the sublingual microcirculation (98) on the other side, the use of the miniaturized extracorporeal circulation sys¬tem is associated with a statistically signifi¬cant reduction in sublingual microcirculato¬ry hypoperfusion compared with the use of the conventional extracorporeal circulation system (99). In off-pump coronary artery by¬pass, cardiac displacement was accompa¬nied by significant decrease of red blood cell velocity (100). During cardiopulmonary by¬pass, different effect of various inhalational anesthetic agents on indices of sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))was shown, sevoflurane had a negative effect on the microcircula¬tion, isoflurane decreased vascular density and increased flow, desflurane produced sta¬ble effects on the microcirculation (101).
Interesting physiological study was pub¬lished just recently, effect of high altitude on sublingual microcirculation (Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))was evaluated in 24 subjects using side stream dark field imag¬ing, as they ascended to 5300 m.; one cohort remained at this altitude, while another as¬cended higher (maximum 8848 m). Among other variables, the Microvascular flow index (MFI) and vessel density were calculated. To¬tal study length was 71 days, images were recorded at sea level (SL), Namche Bazaar (3500 m), Everest base camp (5300 m), the Western Cwm (6400 m), South Col (7950 m) and departure from Everest base camp (5300 m; 5300 m-b). Compared with SL, altitude resulted in reduced sublingual MFI in small (<25 microm; P < 0.0001) and medium vessels (26-50 microm; P = 0.006). The greatest reduction in MFI from SL was seen at 5300 m-b; from 2.8 to 2.5 in small vessels and from 2.9 to 2.4 in medium-sized vessels. The reduction in MFI was greater in climbers than in those who remained at 5300 m ¨C in small and medium-sized vessels (P = 0.017 and P = 0.002, respectively). At 7950 m, ad¬ministration of supplemental oxygen resulted in a further reduction of MFI and increase in vessel density (102).
Summary
In humans, and especially in critically ill pa¬tients, the evaluation of the microcirculation has long been difficult. Recent years have witnessed the development of new tech¬niques that can either directly visualize or in¬directly evaluate microvascular perfusion. Currently, monitoring sublingual microcirculation by OPS/SDF imaging (sublingual microcirculation,Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF))remains the only one possibility how to evaluate patient¡¯s mi¬crocirculation at the bedside. In humans, fur¬ther improvement, particularly in area of de¬veloping rapid, simple and fully automated analyzing tool allowing quantitative assess¬ment during imaging or immediately may help to identify the patients at risk for devel¬oping multiple organ failure linked to insults of various kind. Early detection of microvas¬cular abnormality is a key factor to start early therapeutic intervention to reverse microvas¬cular dysfunction and to achieve better clini¬cal outcome. In experimental setting, observ¬ing sublingual microcirculation(Tongue microcirculation,lingua microcirculation,Side stream dark field imaging (SDF)) is an impor¬tant part of any research focused on the role of microcirculation during various diseases models and to assess effect of different treat¬ment modalities on microcirculation.

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