Department of Intensive Care, Affiliated Hospital of Chengde Medical University, Chengde, China.
Medicine (Baltimore). 2024 Feb 23;103(8):e37273. doi: 10.1097/MD.0000000000037273.
Hemodynamic coherence plays a critical role in the outcomes of septic shock. Due to the potential negative consequences of microcirculatory disorders on organ failure and clinical outcomes, the maintenance of a balance between the macrocirculation and microcirculation is a topic of significant research focus. Although physical methods and specialized imaging techniques are used in clinical practice to assess microcirculation, the use of monitoring devices is not widespread. The integration of microcirculation research tools into clinical practice poses a significant challenge for the future. Consequently, this review aims to evaluate the impact of septic shock on the microcirculation, the methods used to monitor the microcirculation and highlight the importance of microcirculation in the treatment of critically ill patients. In addition, it proposes an evaluation framework that integrates microcirculation monitoring with macrocirculatory parameters. The optimal approach should encompass dynamic, multiparametric, individualized, and continuous monitoring of both the macrocirculation and microcirculation, particularly in cases of hemodynamic separation.
血流动力学相干性在脓毒性休克的预后中起着关键作用。由于微循环障碍对器官衰竭和临床结局的潜在负面影响,维持大循环和微循环之间的平衡是一个重要的研究焦点。尽管在临床实践中使用物理方法和专门的成像技术来评估微循环,但监测设备的使用并不广泛。将微循环研究工具整合到临床实践中是未来的一个重大挑战。因此,本综述旨在评估脓毒性休克对微循环的影响、监测微循环的方法,并强调微循环在危重病患者治疗中的重要性。此外,它提出了一个评估框架,将微循环监测与大循环参数相结合。最佳方法应包括对大循环和微循环进行动态、多参数、个体化和连续监测,特别是在血流动力学分离的情况下。