Michard Frederic, Wong Adrian, Kanoore Edul Vanina
MiCo, Vallamand, Switzerland.
Department of Critical Care, King's College Hospital, London, UK.
Crit Care. 2025 Jan 3;29(1):3. doi: 10.1186/s13054-024-05239-w.
The advancements in cardiovascular imaging over the past two decades have been significant. The miniaturization of ultrasound devices has greatly contributed to their widespread adoption in operating rooms and intensive care units. The integration of AI-enabled tools has further transformed the field by simplifying echocardiographic evaluations and enhancing the reproducibility of hemodynamic measurements, even for less experienced operators. Speckle tracking echocardiography offers a direct, visual, and quantitative assessment of myocardial shortening, serving as a compelling alternative to traditional methods for evaluating right and left ventricular systolic function. In critically ill patients, sublingual microcirculation imaging has revealed a high prevalence of microvascular alterations, which are markers of disease severity. The use of handheld vital microscopes enables the quantification of several key parameters, including vessel density, perfusion, red blood cell velocity, and the perfused vascular density. Such metrics are useful for evaluating microcirculatory health. The development of automated software marks a significant advance toward real-time bedside microvascular assessment. These advancements could eventually allow shock resuscitation to be tailored based on microvascular responses. In parallel with imaging advances, cardiac output monitors have evolved significantly. Once cumbersome devices displaying basic numerical data in tabular form, they now feature sleek, touch-screen interfaces integrated with visual decision-support tools. These tools synthesize hemodynamic data into intuitive graphical formats, allowing clinicians to quickly grasp the determinants of circulatory shock. This visual clarity supports more efficient and accurate decision-making, which may ultimately lead to improved patient care and outcomes.
在过去二十年中，心血管成像技术取得了重大进展。超声设备的小型化极大地促进了其在手术室和重症监护病房的广泛应用。人工智能工具的整合进一步改变了这一领域，它简化了超声心动图评估，并提高了血流动力学测量的可重复性，即使对于经验较少的操作人员也是如此。斑点追踪超声心动图提供了对心肌缩短的直接、可视化和定量评估，是评估左右心室收缩功能的传统方法的有力替代方案。在重症患者中，舌下微循环成像显示微血管改变的发生率很高，这些改变是疾病严重程度的标志物。使用手持式活体显微镜能够对包括血管密度、灌注、红细胞速度和灌注血管密度在内的几个关键参数进行量化。这些指标有助于评估微循环健康状况。自动化软件的开发标志着朝着实时床边微血管评估迈出了重要一步。这些进展最终可能使休克复苏能够根据微血管反应进行调整。与成像技术的进步并行，心输出量监测仪也有了显著发展。这些设备曾经笨重，以表格形式显示基本数值数据，现在则具有简洁的触摸屏界面，并集成了视觉决策支持工具。这些工具将血流动力学数据综合成直观的图形格式，使临床医生能够快速掌握循环性休克的决定因素。这种视觉上的清晰性支持更高效、准确的决策，最终可能改善患者护理和治疗结果。
