Current status of tissue monitoring in the management of shock

Lima, Alexandre

doi:10.1097/mcc.0000000000000300

Cited by 17 publications

(13 citation statements)

References 17 publications

(11 reference statements)

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“…Direct visualization of microcirculation focuses on vascular density, flow, and proportion of perfused vessels [65]. Assessment of microcirculation has been a research tool not applicable in the clinical bedside assessment.…”

Section: Markers Of Local Perfusionmentioning

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: Markers Of Local Perfusionmentioning

confidence: 99%

Perfusion indices revisited

2017

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“…For example, NIRS measurements rely on vascular occlusion test to estimate microvascular reserve and its use is still controversial in the literature, most likely due to the different methodologies used in different trials [1]. Similarly, in order for videos acquired with HVM to be of any use, the microscopist must minimise movement and pressure artefacts, provide adequate focus and illumination, and take an adequate length of video for analysis [5].…”

Section: Problems With Acquisition At the Bedsidementioning

confidence: 99%

“…There is no standardized technique for the arterial occlusion test when using NIRS, and there is a lack of supporting evidence regarding which method is superior and more reliable to assess NIRS-derived microcirculatory data [1,2]. In the field of microcirculation imaging, the most recent update [14] does not recommend routine clinical use for resuscitation since there is lack of consensus on how this might be achieved, and the definition on the reference values for microcirculation-guided resuscitation end points are not yet established.…”

Section: Lack Of Consensusmentioning

confidence: 99%

“…Since these are only surrogate markers of shock, it is appealing to consider the addition of microcirculation data to better inform the physician about the true behaviour of the interface at which shock is most relevant. Recent advances in technology that allow for the acquisition of microcirculatory data, such as transcutaneous oximetry, near-infrared spectroscopy (NIRS), and non-invasive handheld video-microscopy (HVM), make this a tantalising prospect [1]. However, technologies to monitor the microcirculation have been used within the research domain for decades without being adopted into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Could resuscitation be based on microcirculation data? No

Naumann

Lima

2018

Intensive Care Med

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“…(44) Carbon dioxide is approximately 20 times more diffusible than oxygen, and transcutaneous oxygen measurement (PtCO 2 ) is more sensitive to changes in perfusion than transcutaneous carbon dioxide measurement. (44) The oxygen challenge test involves temporarily increasing the inspired oxygen fraction (FiO 2 ) used and monitoring the PtcO 2 response. In patients with normal lung function, increased FiO 2 is associated with a parallel increase in PtcO 2 since, in patients with adequate blood flow, the PtcO 2 and PaO 2 values are almost identical.…”

Section: Microcirculation Assessmentmentioning

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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Current status of tissue monitoring in the management of shock

Abstract: The latest developments of noninvasive optical monitoring and transcutaneous oximetry technologies have helped early identification of septic patients at high risk for microcirculatory failure and could allow more targeted interventions in shock.

Cited by 17 publications

References 17 publications

Perfusion indices revisited

Perfusion indices revisited

Could resuscitation be based on microcirculation data? No

Recent advances in bedside microcirculation assessment in critically ill patients

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