Monitoring the microcirculation

Area of Science:

• Critical care medicine
• Hemodynamics
• Microcirculation research

Background:

• Preserving tissue perfusion is a key goal of hemodynamic support.
• Tissue perfusion depends more on microvascular function than aortic blood flow.
• Direct monitoring of microcirculation has historically been challenging.

Purpose of the Study:

• To review current technologies for monitoring microcirculation at the bedside.
• To discuss the relevance and application of various microcirculation monitoring tools.
• To highlight advancements in assessing microvascular function in critically ill patients.

Main Methods:

• Review of existing literature on microcirculation monitoring techniques.
• Discussion of videomicroscopic devices (e.g., sidestream darkfield imaging).
• Evaluation of indirect methods like tissue PCO2 measurement and near-infrared spectroscopy (NIRS).

Main Results:

• Videomicroscopy (sidestream darkfield imaging) is effective for evaluating heterogeneous microcirculation, especially in sepsis.
• Transcutaneous PCO2 measurement offers a promising indirect assessment of microcirculation.
• NIRS, particularly with vascular occlusion tests, provides insights into microcirculatory reactivity.

Conclusions:

• Technological advances enable bedside monitoring of microcirculation in critically ill patients.
• Various tools, including videomicroscopy, PCO2 monitoring, and NIRS, offer valuable data.
• These methods enhance understanding of sepsis pathophysiology and multiple organ failure.