The future of intensive care: the study of the microcirculation will help to guide our therapies
Abstract The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization o...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04474-x |
| _version_ | 1797682601012494336 |
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| author | J. Duranteau D. De Backer K. Donadello N. I. Shapiro S. D. Hutchings A. Rovas M. Legrand A. Harrois C. Ince |
| author_facet | J. Duranteau D. De Backer K. Donadello N. I. Shapiro S. D. Hutchings A. Rovas M. Legrand A. Harrois C. Ince |
| author_sort | J. Duranteau |
| collection | DOAJ |
| description | Abstract The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients. |
| first_indexed | 2024-03-12T00:02:09Z |
| format | Article |
| id | doaj.art-6a99ad23b47f4615ae0638b045a6bfc1 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T00:02:09Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-6a99ad23b47f4615ae0638b045a6bfc12023-09-17T11:17:09ZengBMCCritical Care1364-85352023-05-0127111310.1186/s13054-023-04474-xThe future of intensive care: the study of the microcirculation will help to guide our therapiesJ. Duranteau0D. De Backer1K. Donadello2N. I. Shapiro3S. D. Hutchings4A. Rovas5M. Legrand6A. Harrois7C. Ince8Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay UniversityDepartment of Intensive Care, CHIREC Hospitals, Université Libre de BruxellesAnaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of VeronaDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center–Harvard Medical SchoolKing’s College Hospital NHS Foundation TrustDivision of General Internal and Emergency Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital MünsterDivision of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSFDepartment of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay UniversityDepartment of Intensive Care, Erasmus MC, University Medical CenterAbstract The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients.https://doi.org/10.1186/s13054-023-04474-xHemodynamic resuscitationMicrocirculationICUHand-held vital microscopesArtificial intelligence |
| spellingShingle | J. Duranteau D. De Backer K. Donadello N. I. Shapiro S. D. Hutchings A. Rovas M. Legrand A. Harrois C. Ince The future of intensive care: the study of the microcirculation will help to guide our therapies Critical Care Hemodynamic resuscitation Microcirculation ICU Hand-held vital microscopes Artificial intelligence |
| title | The future of intensive care: the study of the microcirculation will help to guide our therapies |
| title_full | The future of intensive care: the study of the microcirculation will help to guide our therapies |
| title_fullStr | The future of intensive care: the study of the microcirculation will help to guide our therapies |
| title_full_unstemmed | The future of intensive care: the study of the microcirculation will help to guide our therapies |
| title_short | The future of intensive care: the study of the microcirculation will help to guide our therapies |
| title_sort | future of intensive care the study of the microcirculation will help to guide our therapies |
| topic | Hemodynamic resuscitation Microcirculation ICU Hand-held vital microscopes Artificial intelligence |
| url | https://doi.org/10.1186/s13054-023-04474-x |
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