Integrating microcirculatory imaging, optical oxygenation indices, and cellular redox state to assess tissue vitality

Although modern resuscitation strategies increasingly incorporate parameters such as lactate kinetics and venous oxygenation, clinical practice still predominantly relies on macrocirculatory targets. However, restoring systemic hemodynamics often fails to correct cellular dysoxia due to a loss of hemodynamic coherence. This perspective proposes an integrated framework that assesses tissue vitality by combining microcirculatory imaging, optical oxygenation indices, and mitochondrial redox state. By simultaneously evaluating convective flow, oxygen availability, and metabolic utilization, this multi-domain approach can reveal organ dysfunction and guide resuscitation toward genuine cellular recovery rather than macro-circulatory targets alone.