Microcirculation in Dehydrated Older Patients

Study Overview
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Brief Summary
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This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation This prospective observational study includes clinically dehydrated patients aged ≥ 65 years, who have spontaneous circulation and access to the sublingual mucosa, immediately after admission. Dehydration will be assessed clinically. A sidestream dark field camera (SDF) will be used for measurement. Video-quality will be evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥ 65 years not showing dehydration served as control.

Official Title
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The Analysis of the Sublingual Microvascular Terminal Circuit Improves the Diagnostic and Therapeutic Algorithms in Dehydrated Older Patients- a Prospective Observational Study

Conditions
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Dehydration

Intervention / Treatment
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* Diagnostic Test: Measurement of sublingual microcirculation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 years old or older diagnosed with dehydration according to the clinical impression of the treating physician informed consent the sublingual mucosa had to be accessible. Exclusion Criteria: <65 years Lacking informed consent time-critical disease previous resuscitation inaccessibility of sublingual area

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Measurement of sublingual microcirculation<br> | Diagnostic Test: Measurement of sublingual microcirculation<br>* Measurement of sublingual microcirculation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline of Percentage of Perfusion Vessels [%] | Measurement of sublingual microcirculation by using MicroScan® microscope. AVA 4.3C calculates automatically important microcirculatory values (Percentage of Perfusion Vessels; DeBackerDensity; Perfused DeBackerDensity; Perfused Vessel Density) according to the Second Consensus Conference | at Baseline and after 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Microcirculatory quality score (MIQS) | MIQS by Massey et al. is an established method to validate recorded SDF-videos for their suitability for further analysis. MIQS assigns a score of optimal (0 points), suboptimal but acceptable (1 point), or unacceptable (10 points) to the categories illumination, duration, focus, content, stability, and pressure. The scoring will be done for every recorded video during the offline analysis | at Baseline | 
| Clinical Frailty Scale | The Clinical Frailty Scale (CFS) is a simple model visually describing patients physical conditions with nine classes from very fit (class 1) to terminally ill (class 9) | at Baseline | 
| Barthel scoring | Nursing status will be estimated by the Barthel-Index ranging from 100 points (normal and autonomous) to 0 points (completely depending from nursing). | at Baseline | 
| Mini-Mental-Test scoring | The standardized Mini-Mental-Test 30 is a screening tool for cognitive impairment. The test will be performed directly before SDF-measurement. The best possible result is 30 points, the worst 0 points. Test results up to 24 points can be considered normal | at Baseline | 
| Rate of mortality | 30 days mortality will be assessed using the medical records of the hospital or direct contact to the patient. | 30 days after discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Microcirculation, dehydration, risk stratification