Related Experiment Video
Updated: Jul 1, 2025
Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
Resuscitating the macro- vs. microcirculation in septic shock
Rafael González1,2,3,4, Javier Urbano1,2,3,4, Jesús López-Herce1,2,3,4
1Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón.
Insights
Septic shock in children requires tailored monitoring as improvements in macrocirculation do not always reflect microcirculation changes. Integrating macro, microcirculation, and metabolic monitoring is crucial for effective treatment.
Area of Science:
- Pediatric critical care medicine
- Hemodynamics
- Septic shock research
Background:
- Septic shock management in children presents variable treatment responses.
- Macrocirculatory improvements do not consistently correlate with microcirculatory status during resuscitation.
- Hemodynamic coherence is often lost in pediatric septic shock.
Purpose of the Study:
- To review the relationship between macro and microcirculation in pediatric septic shock.
- To discuss the clinical implications of these circulatory dynamics.
- To highlight the need for advanced monitoring strategies.
Main Methods:
- Literature review of experimental and clinical observational studies.
- Analysis of hemodynamic coherence between macro and microcirculation.
- Evaluation of current monitoring parameters in septic shock.
Main Results:
- Resuscitation responses in septic shock are highly variable.
- Macrocirculatory improvements do not guarantee microcirculatory recovery.
- Optimal monitoring requires integration of macrocirculatory, microcirculatory, and cellular metabolic parameters.
Conclusions:
- Patient-tailored monitoring is essential for adjusting septic shock treatment.
- There is a need for high-quality studies on macrocirculation, microcirculation, and metabolism in pediatric septic shock.
- Development of novel biomarkers for microcirculation and tissue perfusion is necessary.
Purpose Of Review:
This review summarizes current literature about the relationships between macro and microcirculation and their practical clinical implications in children with septic shock.
Recent Findings:
Current evidence from experimental and clinical observational studies in children and adults with septic shock reveals that the response to treatment and resuscitation is widely variable. Furthermore, there is a loss of hemodynamic coherence, as resuscitation-induced improvement in macrocirculation (systemic hemodynamic parameters) does not necessarily result in a parallel improvement in the microcirculation. Therefore, patient-tailored monitoring is essential in order to adjust treatment requirements during resuscitation in septic shock. Optimal monitoring must integrate macrocirculation (heart rate, blood pressure, cardiac output, and ultrasound images), microcirculation (videomicroscopy parameters and capillary refill time) and cellular metabolism (lactic acid, central venous blood oxygen saturation, and difference of central venous to arterial carbon dioxide partial pressure).
Summary:
There is a dire need for high-quality studies to assess the relationships between macrocirculation, microcirculation and tissue metabolism in children with septic shock. The development of reliable and readily available microcirculation and tissue perfusion biomarkers (other than lactic acid) is also necessary to improve monitoring and treatment adjustment in such patients.
More Related Videos
14:28Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care
Published on: May 10, 2024
07:51Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
