Microcirculation in clinical practice

Abstract

Introduction Haemodynamic monitoring is a cornerstone of care in high-risk surgery and critically ill patients. Therapies aimed at optimising haemodynamic targets by means of resuscitation protocols have been demonstrated to improve patient outcomes. Nonetheless, in some specific clinical conditions (e.g. sepsis), due to the loss of vascular tone autoregulation, in spite of cardiac output and mean arterial pressure increase, cellular hypoxia and organ dysfunction may persist. These clinical states are characterised by macrocirculation–microcirculation uncoupling, in which high mortality rates still persist even after macrocirculatory optimisation. Over the last few years, new technologies specifically designed to aid in microcirculatory monitoring have been introduced into the market. This review deals with the most studied and used of these technologies, including videomicroscopic techniques, laser Doppler and near-infrared spectroscopy. The main advantages and limitations of each instrument will be considered. Conclusion We believe that the so-called ‘haemodynamic optimisation’ during and after major surgery is a good and efficacious way to improve patient outcomes. Nevertheless, in critically ill patients, microcirculatory status, usually neglected, should be evaluated and monitored to guide therapies based on a more pathophysiological approach.