Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock

Association of Preoperative Basal Inflammatory State, Measured by Plasma suPAR Levels, with Intraoperative Sublingual Microvascular Perfusion in Patients Undergoing Major Non-Cardiac Surgery

“…However, all the currently used software packages have limitations [ 36 ]. Of note, the AVA4.3C has been used in studies published in journals specializing in microcirculation and in other peer-reviewed journals [ 37 , 38 , 39 , 40 , 49 , 50 , 51 ], while at least three published studies report that the AVA4.3C is a validated automatic algorithm-software [ 37 , 38 , 39 ]. Furthermore, we analyzed several videos at each time, used continuous measurements, which allowed a better comparison over time, and followed the recommended methodology for sublingual microcirculation videos [ 36 ].…”

“…In addition, we did not assess other biomarkers of endothelial cell activation and injury or glycocalyx injury. Although anesthetics may affect microcirculatory flow, we used desflurane for maintenance because it produces stable effects on the microcirculation [ 40 ]. Despite these limitations, the present study is the largest prospective cohort investigating the association between chronic systemic inflammation and sublingual microcirculatory perfusion in perioperative medicine.…”

“…Before analysis, all sublingual perfusion videos were evaluated by two experienced raters blinded to all patient data, according to a modified microcirculation image quality score (MIQS) [ 34 ]. The best three videos from each recording were analyzed offline by a blinded investigator with the AVA4.3C Research Software (Microvision Medical, Amsterdam, the Netherlands) [ 35 , 36 , 37 , 38 , 39 , 40 ]. We analyzed the De Backer score as density score and the Consensus Proportion of Perfused Vessels (Consensus PPV) and Consensus PPV (small) as flow scores.…”

Relationship of Effective Circulating Volume with Sublingual Red Blood Cell Velocity and Microvessel Pressure Difference: A Clinical Investigation and Computational Fluid Dynamics Modeling

“…Other elegant studies have shown that hypoxia and hypercapnia increase mean circulatory filling pressure (Pmcf) and vascular capacitance [ 11 , 12 ], enhancing microcirculatory flow through a physiological adaptation to match oxygen delivery to demand [ 13 , 14 ]. These data could explain, in part, the vessel cluster synchronization in the microcirculatory blood flow of some organs, which changes depending on the condition of the vascular network and the blood pressure (hemodynamic coupling) [ 15 ], suggesting an interplay between effective circulating volume and tissue perfusion [ 11 , 13 , 14 , 16 , 17 , 18 ].…”

Current Challenges in the Management of Sepsis and Septic Shock: Personalized, Physiology-Guided Treatment

“…There remains no clear answer due to the lack of solid evidence. However, multimodal perfusion monitoring and an integrated evaluation of macro- and microcirculatory hemodynamic parameters seem to be necessary additions to the other aspects of care [ 7 , 8 , 9 ]. Furthermore, criteria to assist in the decision of when to stop aggressive treatment must be urgently established, so as to decrease the risk of over-resuscitation.…”