Microcirculation measurements: Barriers for use in clinical routine.

Area of Science:

• Critical care medicine
• Hemodynamics
• Physiology

Background:

• Microcirculatory alterations are common in shock, inflammation, and sepsis.
• Pathophysiology is understood, but microcirculation measurements are not routine.
• Current clinical practice focuses on global hemodynamics, not direct microcirculation targets.

Purpose of the Study:

• To define requirements for clinical microcirculation measurement techniques.
• To identify barriers to implementing these techniques in routine practice.
• To assess current methods for patients with sepsis or undergoing cardiac surgery.

Main Methods:

• Clinical review of available measurement techniques.
• Evaluation of reliability, reproducibility, validity, availability, and usefulness.
• Focus on methods applicable to sepsis and cardiac surgery patients.

Main Results:

• Bedside methods like video microscopy have high variability and lack automated analysis.
• Correlation between microcirculation impairment and outcomes exists, but target parameters are undefined.
• Regional brain oxygenation is recommended but doesn't directly assess microcirculation.

Conclusions:

• International guidelines do not recommend direct microcirculation targets due to a lack of clinically acceptable methods.
• Establishing the validity of microcirculation measurements for improving patient outcomes is crucial.
• More clinical studies are needed to integrate microcirculation assessment into routine care for sepsis, inflammation, and shock.