UNDERSTANDING HEMODYNAMIC INCOHERENCE: MECHANISMS, PHENOTYPES, AND IMPLICATIONS FOR TREATMENT

Area of Science:

• Critical Care Medicine
• Physiology
• Biomedical Engineering

Background:

• Microcirculation dysfunction is a critical indicator of shock resuscitation success and patient prognosis.
• Hemodynamic incoherence, characterized by persistent microcirculatory dysfunction despite restored macrocirculation, presents a significant clinical challenge.
• Technological advancements now permit bedside assessment of microcirculation in shock patients.

Purpose of the Study:

• To review the pathophysiological mechanisms underlying hemodynamic incoherence.
• To introduce current understanding and classification frameworks for hemodynamic incoherence phenotypes.
• To propose a conceptual framework for understanding and potentially classifying hemodynamic incoherence phenotypes.

Main Methods:

• Review of pathophysiological mechanisms leading to hemodynamic incoherence.
• Analysis of existing classification frameworks for hemodynamic incoherence phenotypes.
• Integration of clinical data, including macrocirculation, microcirculation, tissue metabolism, and biomarkers, to define phenotypes.

Main Results:

• Hemodynamic incoherence arises from diverse pathophysiological mechanisms, leading to heterogeneous patient presentations.
• Existing evidence highlights significant variability among patients experiencing hemodynamic incoherence.
• Proposed classification frameworks aim to categorize these diverse phenotypes.

Conclusions:

• Recognizing the heterogeneity of hemodynamic incoherence is crucial for effective patient management.
• A conceptual framework integrating multiple data types can help characterize clinical features of different phenotypes.
• Further validation is required for targeted treatment strategies based on identified phenotypes.