Microvascular Perfusion as a Target for Fluid Resuscitation in Experimental Circulatory Shock*

Genderen, Michel E van; Klijn, Eva; Lima, Alexandre; Jonge, Jeroen de; Visser, Sako; Voorbeijtel, Jacqueline; Bakker, Jan; Bommel, Jasper van

doi:10.1097/ccm.0b013e3182a63fbf

Cited by 52 publications

(35 citation statements)

References 46 publications

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“…In an observational study, Hernandez and colleagues reported that early recovery of peripheral perfusion indices (such CRT, T c-toe , and P (v-a) CO 2 ) is a marker of successful resuscitation of septic shock patients. In an animal study, Van Genderen et al [70] reported a relationship between central and peripheral markers of perfusion during resuscitation of experimental shock; however, the rate of normalization of perfusion markers was dependent on the underlying type of shock. A randomized controlled trial (RCT) investigated the perfusion-based approach during resuscitation of 30 septic shock patients was conducted by the same group of authors [71].…”

Section: Perfusion-guided Resuscitationmentioning

confidence: 99%

Perfusion indices revisited

2017

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Monitoring of tissue perfusion is an essential step in the management of acute circulatory failure. The presence of cellular dysfunction has been a basic component of shock definition even in the absence of hypotension. Monitoring of tissue perfusion includes biomarkers of global tissue perfusion and measures for assessment of perfusion in non-vital organs.The presence of poor tissue perfusion in a shocked patient is usually associated with worse outcome. Persistently impaired perfusion despite adequate resuscitation is also associated with worse outcome. Thus, normalization of some perfusion indices has become one of the resuscitation targets in patients with septic shock.Although the collective evidence shows the clear relation between impaired peripheral perfusion and mortality, the use of different perfusion indices as a resuscitation target needs more research.

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Section: Perfusion-guided Resuscitationmentioning

confidence: 99%

Perfusion indices revisited

2017

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“…(30-33) In cardiogenic shock, for example, all microcirculatory variables undergo change, such as reductions in the diameter of arterioles and the functional capillary density. (30-33) In patients with heart failure, intravenous infusion of nitroglycerin has been able to increase functional capillary density, even with a reduction in cardiac filling pressures, demonstrating the independence of the microcirculation in relation to macro-hemodynamic variables and their dynamic character. (31,32) …”

Section: Microcirculationmentioning

confidence: 99%

Recent advances in bedside microcirculation assessment in critically ill patients

Tafner¹,

Chen²,

Filho³

et al. 2017

Revista Brasileira De Terapia Intensiva

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Parameters related to macrocirculation, such as the mean arterial pressure, central venous pressure, cardiac output, mixed venous saturation and central oxygen saturation, are commonly used in the hemodynamic assessment of critically ill patients. However, several studies have shown that there is a dissociation between these parameters and the state of microcirculation in this group of patients. Techniques that allow direct viewing of the microcirculation are not completely disseminated, nor are they incorporated into the clinical management of patients in shock. The numerous techniques developed for microcirculation assessment include clinical assessment (e.g., peripheral perfusion index and temperature gradient), laser Doppler flowmetry, tissue oxygen assessment electrodes, videomicroscopy (orthogonal polarization spectral imaging, sidestream dark field imaging or incident dark field illumination) and near infrared spectroscopy. In the near future, the monitoring and optimization of tissue perfusion by direct viewing and microcirculation assessment may become a goal to be achieved in the hemodynamic resuscitation of critically ill patients.

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“…Coherence between the systemic circulation and the MC is lost when improvements in systemic parameters are not reflected by improvements in the MC [1]. This issue may occur particularly in states of shock, inflammation, reperfusion, and infection, as well as resuscitation damage to normal cellular sensing mechanisms [1, 51–54, 88]. In adults, the loss of coherence predominately occurs in sepsis [52, 53, 56].…”

Section: Introductionmentioning

confidence: 99%

The vulnerable microcirculation in the critically ill pediatric patient

2016

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In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients. Therefore, the development of non-invasive methods for monitoring the MC is necessary in pediatric critical care for early identification of impending deterioration and to enable the initiation and titration of therapy to ensure cell survival. To date, the MC may be non-invasively monitored at the bedside using hand-held videomicroscopy, which provides useful information regarding the microcirculation. There is an increasing number of studies on the MC in neonates and pediatric patients; however, additional steps are necessary to transition MC monitoring from bench to bedside. The recently introduced concept of hemodynamic coherence describes the relationship between changes in the MC and macrocirculation. The loss of hemodynamic coherence may result in a depressed MC despite an improvement in the macrocirculation, which represents a condition associated with adverse outcomes. In the pediatric intensive care unit, the concept of hemodynamic coherence may function as a framework to develop microcirculatory measurements towards implementation in daily clinical practice.

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Microvascular Perfusion as a Target for Fluid Resuscitation in Experimental Circulatory Shock*

Cited by 52 publications

References 46 publications

Perfusion indices revisited

Perfusion indices revisited

Recent advances in bedside microcirculation assessment in critically ill patients

The vulnerable microcirculation in the critically ill pediatric patient

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