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Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock
Huai-Wu He1, Yun Long1, Da-Wei Liu1
1Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Chinese Medical Journal
|March 22, 2019
Summary
Resuscitation incoherence (RI) occurs when tissue perfusion remains poor despite restored macrocirculation. This review proposes a framework to understand RI and dynamic circulation-perfusion coupling for managing circulatory shock.
Area of Science:
- Critical Care Medicine
- Physiology
- Hemodynamics
Background:
- Persistent poor tissue perfusion and cellular hypoxia can occur even after macrocirculation is restored.
- Understanding the relationship between hemodynamics and tissue perfusion is crucial in managing circulatory shock.
Purpose of the Study:
- To review literature on hemodynamic coherence and tissue perfusion in circulatory shock.
- To introduce a conceptual framework for resuscitation incoherence (RI) and dynamic circulation-perfusion coupling.
Main Methods:
- Literature search of PubMed database up to January 2018.
- Inclusion of peer-reviewed English articles on tissue perfusion, shock, and resuscitation.
- Development of a conceptual framework for RI and circulation-perfusion coupling.
Main Results:
- Resuscitation incoherence (RI) describes a state where macrocirculation is restored but tissue perfusion remains inadequate.
- A four-type framework for RI is proposed, detailing Macro-Micro and Micro-Cell relationships.
- The concept of dynamic circulation-perfusion coupling was introduced to assess circulation-perfusion dynamics.
Conclusions:
- RI and dynamic circulation-perfusion coupling offer valuable insights for managing circulatory shock.
- Further clinical studies are needed to validate these concepts in practice.
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