Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit - the GlycoNurse study.
Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit - the GlycoNurse study.
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DOI：
10.1186/s13049-018-0483-4
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发表时间：
2018-02-14
期刊：
影响因子：
--
通讯作者：
Kümpers P
中科院分区：
文献类型：
--
作者：
Rovas A;Lukasz AH;Vink H;Urban M;Sackarnd J;Pavenstädt H;Kümpers P
内皮糖萼（eGC）是内皮管腔表面的保护性富含碳水化合物的层，其恶化在血管屏障功能障碍和最终在全身炎症反应综合征和脓毒症中的器官衰竭中起关键作用。因此，糖萼损伤的早期检测可能成为重症监护的一个重要目标。本研究旨在确定在急诊室（ER）和重症监护室（ICU）床边进行的定量、实时糖萼测量的可行性和重现性。这项观察性研究包括70名在大学医院急诊室或ICU住院的患者。负责患者的医生和护士使用侧流暗场（SDF）成像进行舌下微循环测量。使用新型数据采集和分析软件（GlycoCheck™）分析灌注边界区域（PBR），这是直径在5 μ m和25 μm之间的血管中内皮糖萼尺寸的逆参数。该方法显示出良好的观察者内重现性。具体而言，组内相关系数分析显示，医生测量值之间的重现性极佳（0.77 [CI 95%：0.52-0.89]）。两个PBR之间的偏差为− 0.077 ± 0.24 μm。此外，护士获得的PBR值与医生报告的PBR值（被视为“金标准”测量）相比没有显著差异。组内相关系数分析显示护士和医生的PBRs之间具有良好的重复性（0.75 [95%CI：0.52-0.87]）。两个PBR之间的平均差（即，偏差为0.007 ± 0.25 μm。护士的PBR评估具有90%的灵敏度（95% CI：60-99%）和90%的特异性（95% CI：80-93%），以识别严重受损的糖萼。通过PBR的非侵入性评估，可以在患者床边精确测量糖萼尺寸。这种评估可以成为标准监测的一部分，并有助于临床决策和临床试验和日常实践中的复苏方案。本文的在线版本（10.1186/s13049-018-0483-4）包含补充材料，可供授权用户使用。
Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU). The observational study included 70 patients admitted to the ER or ICU of a university hospital. A physician and the nurse in charge of the patient performed sublingual microcirculatory measurements using sidestream dark field (SDF) imaging. A novel data acquisition and analysis software (GlycoCheck™) was used to analyze the perfused boundary region (PBR), an inverse parameter of endothelial glycocalyx dimensions in vessels with diameters of between 5 and 25 μm. The method showed a good intra-observer reproducibility. Specifically, intraclass correlation coefficient analysis showed an excellent reproducibility between the physician’s measurements (0.77 [CI 95%: 0.52–0.89]). The bias between the two PBRs was − 0.077 ± 0.24 μm. Moreover, there were no significant differences in the PBR values obtained by the nurses when compared to those reported by the physician (regarded as the “gold standard” measurement). Intraclass correlation coefficient analysis showed excellent reproducibility between the nurses’ and physician’s PBRs (0.75 [95% CI: 0.52–0.87]). The mean difference between the two PBRs (i.e., the bias) was 0.007 ± 0.25 μm. The nurses’ PBR assessment had a 90% sensitivity (95% CI: 60–99%) and 90% specificity (95% CI: 80–93%) to identify a severely impaired glycocalyx. Glycocalyx dimensions can be measured at patients’ bedside precisely by non-invasive assessment of the PBR. This assessment could become part of standard monitoring and contribute to clinical decision-making and resuscitation protocols in clinical trials and daily practice. The online version of this article (10.1186/s13049-018-0483-4) contains supplementary material, which is available to authorized users.
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影响因子：
4.5
作者：
Reitsma, Sietze;Slaaf, Dick W.;Vink, Hans;van Zandvoort, Marc A. M. J.;Egbrink, Mirjam G. A. oude
通讯作者：
Egbrink, Mirjam G. A. oude
DOI：
10.2215/cjn.08160813
发表时间：
2014-04-07
影响因子：
9.8
作者：
Dane, Martijn J. C.;Khairoun, Meriem;Rabelink, Ton J.
通讯作者：
Rabelink, Ton J.
影响因子：
3.7
作者：
Lee DH;Dane MJ;van den Berg BM;Boels MG;van Teeffelen JW;de Mutsert R;den Heijer M;Rosendaal FR;van der Vlag J;van Zonneveld AJ;Vink H;Rabelink TJ;NEO study group
通讯作者：
NEO study group
DOI：
10.1186/s13054-015-0741-z
发表时间：
2015-01-28
期刊：
Critical care (London, England)
影响因子：
--
作者：
Chelazzi C;Villa G;Mancinelli P;De Gaudio AR;Adembri C
通讯作者：
Adembri C
影响因子：
82.9
作者：
Schmidt, Eric P.;Yang, Yimu;Janssen, William J.;Gandjeva, Aneta;Perez, Mario J.;Barthel, Lea;Zemans, Rachel L.;Bowman, Joel C.;Koyanagi, Dan E.;Yunt, Zulma X.;Smith, Lynelle P.;Cheng, Sara S.;Overdier, Katherine H.;Thompson, Kathy R.;Geraci, Mark W.;Douglas, Ivor S.;Pearse, David B.;Tuder, Rubin M.
通讯作者：
Tuder, Rubin M.