By Mesenteric microcirculation and barrier functionLeave a Comment on Intravital Microscopy

A diagnostic imaging technique that uses a microscope to visualize the microcirculation and cellular function in living tissue, which can be used to assess gastrointestinal function and injury.

Feasibility/Equipment: Could theoretically be used at bedside, but requires specific equipment and specific training and is not yet established in clinical practice outside of studies. Evaluation of images is time-consuming.

Scoring information: none

Cost: high costs related to equipment and training of personnel

Evidence: Most evidence is coming from experimental research, while different modalities have been studied [1-4]. In humans, it has been used during GI surgery [5] Some studies have assessed whether sublingual microcirculation (more easily accessible) could be used as a surrogate for intestinal microcirculation in critically ill, but have failed to confirm a good correlation [6,7]. There is some enthusiasm about intravital microscopy as a future tool to assess microcirculation for hemodynamic management (not GI function) [8].

References

  1. Martínez-Sánchez LD, Pradhan R, Ngo PA, Erkert L, Becker LS, Watson AJ, Atreya I, Neurath MF, López-Posadas R. An Intravital Microscopy-Based Approach to Assess Intestinal Permeability and Epithelial Cell Shedding Performance. J Vis Exp. 2020 Dec 3;(166). doi: 10.3791/60790.
  2. Tanaka, K., Toiyama, Y., Inoue, Y. et al. Intravital imaging of gastrointestinal diseases in preclinical models using two-photon laser scanning microscopy. Surg Today 2013; 43:123–129. https://doi.org/10.1007/s00595-012-0283-9.
  3. Honda, M., Kadohisa, M., Yoshii, D. et al. Intravital imaging of immune responses in intestinal inflammation. Inflamm Regener 2023; 43:9. https://doi.org/10.1186/s41232-023-00262-w.
  4. Ospina-Tascón GA, García Marin AF, Echeverri GJ, Bermudez WF, Madriñán-Navia H, Valencia JD, Quiñones E, Rodríguez F, Marulanda A, Arango-Dávila CA, Bruhn A, Hernández G, De Backer D. Effects of dobutamine on intestinal microvascular blood flow heterogeneity and O2 extraction during septic shock. J Appl Physiol (1985). 2017 Jun 1;122(6):1406-1417. doi: 10.1152/japplphysiol.00886.2016.
  5. de Bruin AF, Kornmann VN, van der Sloot K, van Vugt JL, Gosselink MP, Smits A, Van Ramshorst B, Boerma EC, Noordzij PG, Boerma D, van Iterson M. Sidestream dark field imaging of the serosal microcirculation during gastrointestinal surgery. Colorectal Dis. 2016 Mar;18(3):O103-10. doi: 10.1111/codi.13250.
  6. Edul VS, Ince C, Navarro N, Previgliano L, Risso-Vazquez A, Rubatto PN, Dubin A. Dissociation between sublingual and gut microcirculation in the response to a fluid challenge in postoperative patients with abdominal sepsis. Ann Intensive Care. 2014 Dec 4;4:39. doi: 10.1186/s13613-014-0039-3.
  7. Boerma EC, van der Voort PH, Spronk PE, Ince C. Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis. Crit Care Med. 2007 Apr;35(4):1055-60. doi: 10.1097/01.CCM.0000259527.89927.F9. 
  8. Duranteau J, De Backer D, Donadello K, Shapiro NI, Hutchings SD, Rovas A, Legrand M, Harrois A, Ince C. The future of intensive care: the study of the microcirculation will help to guide our therapies. Crit Care. 2023 May 16;27(1):190. doi: 10.1186/s13054-023-04474-x.

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