Is microcirculatory assessment ready for regular use in clinical practice?

Area of Science:

• Critical care medicine
• Hemodynamic monitoring
• Microcirculation research

Background:

• Microvascular perfusion is frequently altered in critically ill patients, particularly those with sepsis.
• These microcirculatory alterations correlate with organ dysfunction and adverse patient outcomes.
• Assessing microcirculation is crucial for optimizing hemodynamic management in critical care.

Purpose of the Study:

• To review the current role and limitations of microcirculatory assessment in critically ill patients.
• To explore various techniques for evaluating microvascular perfusion at the bedside.
• To discuss the challenges hindering the widespread clinical adoption of these assessment methods.

Main Methods:

• Review of videomicroscopic techniques for sublingual microcirculation assessment.
• Discussion of vasoreactivity tests (occlusion, thermal challenge).
• Exploration of glycocalyx biomarkers and venoarterial PCO2 differences as surrogates.

Main Results:

• Videomicroscopy reveals microcirculatory alterations in sepsis, linked to poor outcomes.
• Sublingual microcirculation assessment has limitations regarding representativity and applicability.
• Vasoreactivity tests assess maximal dilation but not actual perfusion; glycocalyx evaluation is experimental.
• Venoarterial PCO2 differences offer a surrogate but face practical and standardization challenges.

Conclusions:

• Bedside clinical and biological surrogates for microcirculatory assessment are available.
• Microvideoscopic techniques are limited by the lack of defined targets and specific interventions.
• Further research is needed to overcome limitations and integrate microcirculatory assessment into routine critical care.