The following is a summary of “Nailfold videocapillaroscopy – a novel method for the assessment of hemodynamic incoherence on the ICU,” published in the December 2024 issue of Critical Care by Kintrup et al.
Loss of hemodynamic coherence in patients with critically illness, characterized by microcirculatory disturbances despite adequate vital parameters, can be assessed using methods like incident darkfield microscopy (IDF) and nailfold videocapillaroscopy (NVC).
Researchers conducted a retrospective study to compare NVC with consensus microcirculatory assessments using IDF in individuals with critical illness.
They developed the capillary microcirculation (CapMic) score, ranging from 0 (no microcirculation) to 1 (fully preserved microcirculation), by evaluating 4 nailfold regions on digitus III, IV, and V in 10 healthy volunteers. The CapMic score was compared with the Microangiopathy Evolution Score (MES), a standardized tool for NVC in chronic diseases. Subsequently, 60 individuals with critical illness were enrolled in a surgical ICU, and a single time-point comparison was made between consensus-defined IDF microscopy scores and NVC data.
The results showed significant changes in the CapMic score among 10 healthy volunteers at rest vs during iatrogenic limb ischemia (0.80 ± 0.03 vs. 0.51 ± 0.12, P < 0.001). In individuals with critically illness, inverse correlations were observed between the MES and both the proportion of perfused vessels (PPV) (Spearman’s R = -0.590, P < 0.001) and microvascular flow index (MFI) (Spearman’s R = -0.585, P < 0.001). Positive correlations were found between the CapMic score and PPV (Spearman’s R = 0.714, P < 0.001) and MFI (Spearman’s R = 0.711, P < 0.001), while MES showed an inverse correlation with the CapMic score (Spearman’s R = -0.610, P < 0.001). Both sublingual and nailfold microcirculation worsened with increasing norepinephrine and crystalloid volume requirements.
Investigators concluded that NVC provides comparable information on microcirculation in patients with critical illness to sublingual IDF microscopy, suggesting its potential as a new tool for diagnosing microcirculatory parameters in the ICU.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05194-6
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