Sepsis Study Overview

Investigating microcirculatory dysfunction in ER and ICU sepsis patients using new Microscan imaging technology

PI: Nathan Shapiro, MD, MPH

Background: It is believed that many of the pathophysiologic effects of sepsis are caused by alterations in the microvascular circulation to tissues, independent of arterial blood pressure changes. An imaging technique using Orthogonal Polarization Spectral (OPS) technology was initially developed to visualize these microcirculatory changes, but it required large, high powered light sources that are inconvenient for use in the ICU and ED settings. This led to the development of a portable device called Microscan, which uses a small probe and low-powered, high-intensity bright light emitting diodes (LEDs) to directly illuminate and magnify tissue and provide real-time video of microcirculatory flow. Identification of microcirculatory dysfunction may allow for earlier detection in patients at risk for systemic inflammatory syndromes, sepsis, and septic shock, enabling clinicians to implement earlier antibiotic treatment and goal directed therapy. It may also be useful as a risk stratification tool.

Summary: This is a prospective, cohort study that will analyze the microcirculation of the sublingual mucosa in ED and ICU patients with suspected infection and compare them to healthy controls. The primary outcome measure will be a calculated microcirculatory flow index, which involves scoring the flow in each Microscan video clip as follows: no flow (0 points), intermittent flow (1 point), sluggish flow (2 points), or continuous flow (3 points). Secondary outcome measures will be ICU admission, organ failure, length of stay, SOFA (organ dysfunction/failure) score, and APACHE-II (disease severity) score.