Table 3.
Summary of critically ill pediatric studies using handheld vital microscopy (HVM).
| Reference | Critical illness | Patient (n) | Groups (n) | HVM | Site | Intervention | Outcome |
|---|---|---|---|---|---|---|---|
| Top et al. (37) | Septic Shock | 18 | Survivor: 15 Non-survivor: 3 |
OPS | Buccal mucosa | Fluids Vasopressor Inotropes |
Survivors:
Non-survivors:
|
| Paize et al. (38) | MCD | 60 | MCD: 20 Control: 40 -Anesthesia 20 -Awake 20 |
SDF | Subling | Mechanical ventilation and management for MCD, anesthesia for routine procedures | The study combined HVM with endothelial biomarkers. Decreased MFI, PPV, and PPD in MCD. Initial MFI predicted the duration of mechanical ventilation in MCD. Altered MC correlated with endothelial biomarkers levels. |
| Scolletta et al. (39) | CHD | 24 | Cyanosis: 7 Non-cyanotic 14 |
SDF | Subling | Anesthesia, CPB, RBC management | TVD, PPV, PVD, and MFI are different between cyanotic and non-cyanotic patients, Increased PPV observed over time in the cyanotic group. |
| Gonzalez et al. (40) | CHD | 30 | Cyanosis: 14 Non-cyanosis 16 |
SDF | Subling | Anesthesia in CHD repair | Cyanotic:
|
| Gonzalez et al. (41) | PICU | 18 | T1 = 15 T2 = 9 T1 and T2 = 6 |
SDF | Subling | PICU admission for more than 24 h | Patients evaluated on admission (T1) and day 3 (T3). No correlation with PICU length of stay, mechanical ventilation, vasoactive drug therapy or ECMO. Small number of patients. |
| Gonzalez Cortes et al. (42) | CHD | 24 | All congenital heart disease | SDF | Subling | CPB | Microcirculatory parameters worsened during CPB and returned to baseline after surgery. Children with CHD have higher small vessel density and higher density of perfused small vessel at baseline; lower MFI and higher heterogeneity during surgery. |
| Erdem et al. (43) | ECMO | 34 | VV ECMO 12 VA ECMO 22 |
IDF | Subling | Data collected before and during ECMO | No effect was observed in the ECMO populations using HVM before or during treatment |
| Erdem et al. (44) | CHD | 73 | CHD, CPB 38 Elective, non-cardiac 35 |
IDF | Subling | CHD and surgery with CPB compared to non-cardiac surgical patients | Patients with CHD have decreased microcirculatory perfusion and higher small densities compared to control group. After CPB, microcirculation is further impaired. |
| Nussbaum et al. (45) | CHD | 55 | CPB CHD: 36 -CHD, no CPB 4, Control: 15 -Cath: 6, -Cleft palate: 9 | SDF + Glyco check soft-ware | Ear conch | CPB | Decreased MFI and PVD in CPB after heart surgery. CPB induces endothelial glycocalyx thickness and microvascular perfusion dysregulation. |
| Buijis et al. (46) | Cardiac Arrest (CA) | 40 | CA, ROSC: 20 Control: 20 |
SDF | Buccal mucosa | Therapeutic Hypothermia (in CA) | PVD and MFI lower in non-survivors starting hypothermia. HVM for possible prognostication in CA ROSC. |
| Schinagl et al. (47) | Anemia | 37 | Anemia: 19 Control: 18 |
SDF | Buccal mucosa | Red blood cell transfusion | TVD was lower and RBC velocity higher pre-transfusion. Microcirculation improved after transfusion. |
| Fernandez et al. (48) | MIS-C | 3 | MIS-C: 2 Control: 1 |
SDF + Glyco check soft-ware | Subling | Vasoactive support and steroid treatment | PBR (perfused boundary region) demonstrated endothelial glycocalyx damage in patients with MIS-C. |
| Fernandez et al. (49) | Sepsis Septic shock |
106 | Balanced fluid resuscitation: 48 Unbalanced fluid resuscitation: 58 |
SDF + Glyco check soft-ware | Subling | IV fluid resuscitation | Children with sepsis have worsening endothelial glycocalyx dysfunction when unbalanced crystalloid boluses are used for resuscitation (normal saline) compared to balanced fluids such as lactate ringers. |
| Hilty et al. (50) | Periop and critical illness | 267 | Control: 40 Pediatric P: 10 Adult P: 72 Adult ICU: 145 |
SDF + AVA software | Subling | MicroTools software assessment | MicroTools software validation over a wide range of perioperative and critically ill patient populations using data-mining |
| Lyimo et al. (51) | Malaria | 119 | Control: 31 Severe malaria: 69 Other: 19 |
IDF + software to calculate PBR | Buccal mucosa | Standard malaria treatment | PBR was significantly increased in patients with severe malaria (thin glycocalyx). Plasma elevation of heparan sulfate, syndecan-1, HA, GAG (glycocalyx). Elevation angiopoietin-2, thrombomodulin, endothelin-1 (endothelium). |
| Wagner et al. (52) | Major surgery thorax & abdomen | 11 | No control Major surgery: 11 | SDF + AVA + Glyco check | Subling | Perioperative monitoring in high-risk surgery Fluid resuscitation, Norepinephrine |
Capillary density reduced after surgery started. Microvascular flow and serum glycocalyx markers (syndecan-1 and hyaluronan) increased. PBR |
FCD, functional capillary density; MFI, microvascular flow index; CHD, congenital heart disease; SR, systematic review; OPS, orthogonal polarized spectra; SDF, sidestream dark field; IDF, incident dark field; CAVM, computer-assisted video microscopy; DRS, diffuse reflectance spectroscopy; CBP, cardiopulmonary bypass; PICU, pediatric intensive care unit; RBC, red blood cell; MCD, meningococcal disease; MC, microcirculation; PRISM, pediatric risk of mortality; LTH, local thermal hyperemia; ROSC, return of spontaneous circulation; CDH, congenital diaphragmatic hernia; MIS-C, multisystem inflammatory syndrome-COVID; IDF, incident dark-field imaging; HA, hyaluronic acid; GAG, sulfated glycosaminoglycan.