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Related Concept Videos

Blood Pressure Imbalances and Circulatory Shock01:24

Blood Pressure Imbalances and Circulatory Shock

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Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Related Experiment Video

Updated: Jul 27, 2025

Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care
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Direct assessment of microcirculation in shock: a randomized-controlled multicenter study.

Raphael Romano Bruno1, Jakob Wollborn2, Karl Fengler3

  • 1Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.

Intensive Care Medicine
|June 6, 2023
PubMed
Summary

This study found that using sublingual microcirculatory perfusion variables in shock management did not reduce 30-day mortality. While it led to more treatment adjustments, patient survival rates remained unchanged.

Keywords:
Intensive careIntravital microscopyMicrocirculationShockSidestream-dark field video microscope

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Area of Science:

  • Critical Care Medicine
  • Cardiovascular Research
  • Medical Technology

Background:

  • Shock is a critical condition involving microcirculatory dysfunction.
  • Early identification and management of microcirculatory alterations are crucial for patient outcomes.

Purpose of the Study:

  • To test if integrating sublingual microcirculatory perfusion variables into therapeutic management reduces 30-day mortality in intensive care unit (ICU) patients with shock.
  • To evaluate the impact of microcirculatory-guided therapy on patient survival and other clinical outcomes.

Main Methods:

  • A randomized, prospective, multicenter clinical trial involving 141 ICU patients with shock.
  • Sublingual microcirculation was assessed using sidestream-dark field (SDF) microscopy at ICU admission and 24 hours.
  • Patients were randomized to either routine care or therapy guided by microcirculatory variables.

Main Results:

  • The intervention group showed significantly more adjustments in vasoactive drugs or fluids (66.7% vs. 41.8%, p=0.009).
  • No significant difference was observed in 30-day mortality between the intervention and routine care groups (47.1% vs. 34.7%, HR 1.54, p=0.118).
  • Secondary endpoints like ICU and hospital length of stay and 6-month mortality were not significantly different.

Conclusions:

  • Integrating sublingual microcirculatory perfusion variables into shock management led to treatment modifications but did not improve 30-day survival.
  • Current evidence does not support the routine use of sublingual microcirculatory monitoring to enhance mortality outcomes in shock patients.