Dilken Olcay, Ergin Bulent, Ince Can
Department of Intensive Care Med, Laboratory of Translational Intensive Care Med, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Intensive Care, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Ann Transl Med. 2020 Jun;8(12):793. doi: 10.21037/atm.2020.03.222.
The main concern in shock and resuscitation is whether the microcirculation can carry adequate oxygen to the tissues and remove waste. Identification of an intact coherence between macro- and microcirculation during states of shock and resuscitation shows a functioning regulatory mechanism. However, loss of hemodynamic coherence between the macro and microcirculation can be encountered frequently in sepsis, cardiogenic shock, or any hemodynamically compromised patient. This loss of hemodynamic coherence results in an improvement in macrohemodynamic parameters following resuscitation without a parallel improvement in microcirculation resulting in tissue hypoxia and tissue compromise. Hand-held vital microscopes (HVMs) can visualize the microcirculation and help to diagnose the nature of microcirculatory shock. Although treatment with the sole aim of recruiting the microcirculation is as yet not realized, interventions can be tailored to the needs of the patient while monitoring sublingual microcirculation. With the help of the newly introduced software, called MicroTools, we believe sublingual microcirculation monitoring and diagnosis will be an essential point-of-care tool in managing shock patients.
休克和复苏过程中的主要关注点在于微循环能否为组织输送足够的氧气并清除废物。在休克和复苏状态下，若宏观循环与微循环之间存在完整的连贯性，则表明存在有效的调节机制。然而，在脓毒症、心源性休克或任何血流动力学受损的患者中，宏观循环与微循环之间经常会出现血流动力学连贯性丧失的情况。这种血流动力学连贯性的丧失导致复苏后宏观血流动力学参数有所改善，但微循环却未随之得到平行改善，进而导致组织缺氧和组织损伤。手持式活体显微镜（HVM）能够观察微循环，有助于诊断微循环休克的性质。尽管目前尚未实现仅以恢复微循环为目标的治疗方法，但在监测舌下微循环的同时，可以根据患者的需求进行干预。借助新推出的名为MicroTools的软件，我们相信舌下微循环监测和诊断将成为管理休克患者时必不可少的床旁护理工具。
