Hemodynamic Monitoring in Sepsis—A Conceptual Framework of Macro- and Microcirculatory Alterations

Abstract

Circulatory failure in sepsis is common and places a considerable burden on healthcare systems. It is associated with an increased likelihood of mortality, and timely recognition is a prerequisite to ensure optimum results. While there is consensus that aggressive source control, adequate antimicrobial therapy and hemodynamic management constitute crucial determinants of outcome, discussion remains about the best way to achieve each of these core principles. Sound cardiovascular support rests on tailored fluid resuscitation and vasopressor therapy. To this end, an overarching framework to improve cardiovascular dynamics has been a recurring theme in modern critical care. The object of this review is to examine the nature of one such framework that acknowledges the growing importance of adaptive hemodynamic support combining macro- and microhemodynamic variables to produce adequate tissue perfusion.

Increased tissue water in patients with severe sepsis affects tissue oxygenation measured by near-infrared spectroscopy: a prospective, observational case-control study

“…The primary function of the circulatory system is to deliver nutrients and oxygen to the organs and tissues and remove waste products. The ultimate goal of treating sepsis-related circulatory dysfunction is to restore microcirculation to provide adequate tissue perfusion and oxygenation to prevent eventual multiple organ failure (12,13). Therefore, monitoring tissue perfusion and oxygenation is essential for managing sepsis-related circulatory dysfunction.…”

Optical coherence tomography angiography as a surrogate marker for end-organ resuscitation in sepsis: A review

“…It is therefore important to have precise haemodynamic recording and analysis to ensure that the supportive interventions are adequate to improve outcomes. Myocardial and peripheral vascular dysfunction are equally important in sepsis, with functional assessment of cardiovascular reserve and vessel perfusion necessary to ensure that end-organ blood flow is maintained, ultimately preventing critical organ failure ( 26 ).…”

“…Monitoring mean arterial pressure (MAP) is a standard assessment in sepsis as it approximates organ perfusion pressure, with a MAP of <70 mmHg deemed a criteria point for sepsis ( 1 ). Cardiac output is also monitored during sepsis and acts as an indicator of response to treatment ( 26 ). Cardiac output measurements such as pulmonary artery catheter, aortic velocimetry, arterial waveform analysis and trans oesophageal echocardiography do not measure or estimate microcirculatory dysfunction in the brain ( 27 ).…”

Evaluation of Shoulder Microcirculation Abnormality Using Laser Doppler Flowmetry

“…Salgado [ 11 ] discussed several techniques for evaluating microvasculature perfusion, such as LDF, intravital microscopy, and orthogonal polarization spectral imaging techniques. The capillary refill time constitutes an accessible route for probing microcirculation, which is applied during shock resuscitation [ 12 ]. Valid and reliable biomarkers could be used to objectively evaluate the effects of medical treatments and workplace interventions [ 10 ].…”