Abstract
Various noninvasive microscopic camera technologies have been used to visualize the sublingual microcirculation in patients. We describe a comprehensive approach to bedside in vivo sublingual microcirculation video image capture and analysis techniques in the human clinical setting. We present a user perspective and guide suitable for clinical researchers and developers interested in the capture and analysis of sublingual microcirculatory flow videos. We review basic differences in the cameras, optics, light sources, operation, and digital image capture. We describe common techniques for image acquisition and discuss aspects of video data management, including data transfer, metadata, and database design and utilization to facilitate the image analysis pipeline. We outline image analysis techniques and reporting including video preprocessing and image quality evaluation. Finally, we propose a framework for future directions in the field of microcirculatory flow videomicroscopy acquisition and analysis. Although automated scoring systems have not been sufficiently robust for widespread clinical or research use to date, we discuss promising innovations that are driving new development.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1213-9) contains supplementary material, which is available to authorized users.
Highlights
Recent methodological studies comparing sidestream dark-field (SDF) imaging and CytoCam incident dark-field (IDF) imaging in healthy subjects [40] and neonates [35] observed 20–30 % more capillaries using CytoCam IDF than when using SDF in the same subjects. These differences may be due to a combination of: the IDF light source design that directs the illumination toward the optical axis; an enhanced depth of focus and resolution because of the greater sensor pixel density; and a sharper multi-element objective lens
We have previously proposed a set of objective criteria for evaluating image acquisition quality that may be used to select images appropriate for analysis [21]
The pedals are mapped to keyboard shortcuts specified by the SDF/IDF manufacturer to step through the user interface (UI) and to start/stop scanning
Summary
Orthogonal polarization spectral (OPS) imaging [1] and its successors, sidestream dark-field (SDF) imaging and CytoCam (Braedius Medical B.V., Huizen, the Netherlands) incident dark-field (IDF) imaging, are techniques that allow visualization of the sublingual microcirculation at the bedside. Massey and Shapiro Critical Care (2016) 20:35 to oxygen exchange, analysis of microvascular flow typically focuses on the 0–20 μm vessels
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