Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit: the GlycoNurse study

Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstadt, Philipp Kumpers*

*Corresponding author for this work

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Abstract

Background: 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). Methods: 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 T) 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 mu m. Results: 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 mu m. 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 mu m. 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. Conclusion: 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.
Original languageEnglish
Article number16
Number of pages8
JournalScandinavian Journal of Trauma Resuscitation & Emergency Medicine
Volume26
DOIs
Publication statusPublished - 14 Feb 2018

Keywords

  • Endothelial glycocalyx
  • Perfused boundary region
  • Intravital microscopy
  • Sidestream darkfield microscopy
  • Emergency room
  • Intensive care unit
  • ENDOTHELIAL GLYCOCALYX
  • SEVERE SEPSIS
  • MICROCIRCULATORY ALTERATIONS
  • PERMEABILITY BARRIER
  • ASSOCIATION
  • DYSFUNCTION
  • ADHESION
  • DISEASE
  • PLASMA
  • INJURY

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