Targeting the microcirculation in resuscitation of acutely unwell patients

Harrois, Anatole; Dupic, Laurent; Duranteau, Jacques

doi:10.1097/mcc.0b013e3283466ba0

Cited by 44 publications

(19 citation statements)

References 31 publications

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“…No death was observed during the later course. But the ICU length of stay was significantly longer in patients with SOFA score greater than or equal to 6 at D4 compared to patients with SOFA score less than or equal to 6 By contrast, PPV, MFI, and FCD were significantly decreased in hemorrhagic shock patients compared to the control group, with a significant improvement within the first 4 days of the study (Figs. 1-3).…”

Section: Resultsmentioning

confidence: 56%

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Microcirculatory Alterations in Traumatic Hemorrhagic Shock*

Tachon

Harrois

Tanaka

et al. 2014

Critical Care Medicine

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Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.

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Section: Resultsmentioning

confidence: 56%

“…Heterogeneity MFI was significantly increased at D1 and D2 in high SOFA score patients at D4 compared to low SOFA score patients at D4 (p = 0.01 and p = 0.01, respectively). In addition, PPV at D1 shows to be the variable with the highest predictive value of a SOFA score greater than or equal to 6 (Fig. 5).…”

Section: Resultsmentioning

confidence: 95%

Microcirculatory Alterations in Traumatic Hemorrhagic Shock*

Tachon

Harrois

Tanaka

et al. 2014

Critical Care Medicine

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162

126

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“…Using OPS imaging we were the first to image the human brain microcirculation during surgery [21]. Since then, numerous studies have been undertaken in various clinical scenarios where cardiovascular function is at risk (for example, [1-3,7,8,10,11]).…”

Section: Brief History Of Clinical Imaging Of the Microcirculationmentioning

confidence: 99%

“…Therefore, rather than limiting therapy to macrocirculatory targets alone, microcirculatory targets could be incorporated to potentially reduce mortality rates in these critically ill patients [8-11]. Although an association between an abnormal microcirculation and adverse outcome may be confirmed world-wide, this does not imply that improving the microcirculation in these conditions will improve outcome of these patients.…”

Section: Targeting the Microcirculationmentioning

confidence: 99%

“…This is the main reason why monitoring systemic hemodynamic-derived and oxygen-derived variables is not able to sense such microcirculatory dysfunction. Therefore, rather than limiting (early) goal-directed therapy to macrocirculatory targets alone, microcirculatory targets could be incorporated to more effectively resuscitate the microcirculation and thereby potentially reduce mortality rates in these critically ill patients [8-11]. However, no such clinical study exists to date.…”

Section: Introductionmentioning

confidence: 99%

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Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill - where do we stand?

et al. 2012

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A growing body of evidence exists associating depressed microcirculatory function and morbidity and mortality in a wide array of clinical scenarios. It has been suggested that volume replacement therapy using fluids and/or blood in combination with vasoactive agents to modulate macro- and microvascular perfusion might be essential for resuscitation of severely septic patients. Even after interventions effectively optimizing macrocirculatory hemodynamics, however, high mortality rates still persist in critically ill and especially in septic patients. Therefore, rather than limiting therapy to macrocirculatory targets alone, microcirculatory targets could be incorporated to potentially reduce mortality rates in these critically ill patients. In the present review we first provide a brief history of clinical imaging of the microcirculation and describe how microcirculatory imaging has been of prognostic value in intensive care patients. We then give an overview of therapies potentially improving the microcirculation in critically ill patients and propose a clinical trial aimed at demonstrating that therapy targeting improvement of the microcirculation results in improved organ function in patients with severe sepsis and septic shock. We end with some recent technological advances in clinical microcirculatory image acquisition and analysis.

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