Blind spot in sepsis management - Tissue level changes in microcirculation.

Area of Science:

• Critical care medicine
• Microcirculation research
• Sepsis pathophysiology

Background:

• Sepsis involves inflammation, clotting, and glycocalyx shedding, impairing microcirculation and causing dysoxia (imbalance in mitochondrial respiration).
• Microvascular injuries in sepsis present as cytotoxic edema, heterogeneity, sluggish flow, or focal anemia, indicating diverse pathologies.

Purpose of the Study:

• To explore the potential of recognizing diverse microcirculatory pathologies in sepsis using novel biomarkers.
• To investigate how identifying sepsis subtypes can improve disease stratification and treatment response prediction.
• To highlight the need for reliable diagnostic tools for real-time microcirculation assessment in critically ill patients.

Main Methods:

• Review of experimental evidence on microcirculatory flow, organ dysfunction, and mortality in sepsis.
• Discussion of point-of-care devices for accessing sublingual and nailfold microcirculation.
• Emphasis on the need for validation studies to establish feasibility, reliability, and reproducibility.

Main Results:

• Impaired microcirculatory flow is linked to organ dysfunction and mortality in sepsis.
• Point-of-care microcameras offer accessible real-time microcirculation data.
• Individualized resuscitation strategies based on microcirculatory assessment may optimize fluid and vasopressor administration.

Conclusions:

• Recognizing microcirculatory heterogeneity in sepsis can lead to better patient stratification and personalized treatment.
• Point-of-care microcirculation assessment holds promise for guiding sepsis management and improving outcomes.
• Further validation studies are crucial before widespread clinical adoption of these novel diagnostic tools.