Abstract
INTRODUCTION: Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection. Alterations of microvascular perfusion caused by endothelial cell dysfunction, glycocalyx degradation, increased leukocyte adhesion, microthrombus formation, and regional redistribution of blood flow contribute to the development of multiple organ dysfunction in patients with sepsis. Sublingual videocapillaroscopy is a non-invasive diagnostic tool that allows for a good visualization of microscopic alterations that sometimes represent the only evidence of disease onset. OBJECTIVES: Identification of pathognomonic parameters (microcirculatory alterations) at the oral microcirculation level in patients with sepsis and implementation of an early diagnosis protocol for sepsis/septic shock based on videocapilaroscopic examination. MATERIALS AND METHODS: The study was conducted with a prototype of device (patent application RO/A00285/2018) which received international validation through multiple awards at the most prestigious invention events in which it participated. and was prospective, controlled, analytical, non-randomized, multicenter, in which 255 images from 51 patients was analyzed following the next parameters: orientation of the capillaries in relation to the surface of the mucosa, the presence/absence of the microhemorrhages, the capillary density and the capillary caliber. The working methodology involved the acquisition and preparation of the images, as well as the analysis and software interpretation of them. Further development of the prototype of device will allow us to continue studying and examining a wider range of parameters. RESULTS: Analyzing of the parameter in clinical situations of sepsis reveals an increase in both the number of capillaries in parallel and perpendicular incidence, an increase of capillary caliber and an increase in the density of capillaries. Presence of the microhemorrhages in the oral mucosa it may be observed only in sepsis situations. DISCUSSIONS: The development of a diagnosis and treatment algorithm based on non-invasive examination of oral microcirculation will lead to prompt improvement of hemodynamics and stop the progression of sepsis to severe forms of disease. The presence of the microhemorrhages in the oral mucosa is pathognomonic for the sepsis diagnosis in patients with the biological data which also support this. Our study demonstrates that the use of videocapillaroscopy in current clinical practice can lead to the development of innovative and preventive medical procedures and protocols of high scientific value to solve complex, vital therapeutic problems based on early diagnosis and certainty for the benefit of patients. The study opens new perspectives in the prospective interdisciplinary research (medicine, IT, optical engineering).