Microcirculation-guided resuscitation in sepsis: the next frontier?
Microcirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during seps...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1212321/full |
| _version_ | 1797787130434420736 |
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| author | Elisa Damiani Elisa Damiani Andrea Carsetti Andrea Carsetti Erika Casarotta Roberta Domizi Claudia Scorcella Abele Donati Abele Donati Erica Adrario Erica Adrario |
| author_facet | Elisa Damiani Elisa Damiani Andrea Carsetti Andrea Carsetti Erika Casarotta Roberta Domizi Claudia Scorcella Abele Donati Abele Donati Erica Adrario Erica Adrario |
| author_sort | Elisa Damiani |
| collection | DOAJ |
| description | Microcirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during sepsis and are associated with poor outcome. More importantly, sublingual videomicroscopy allowed to explore the effects of commonly applied resuscitative treatments in septic shock, such as fluids, vasopressors and inotropes, and showed that the optimization of macro-hemodynamic parameters may not be accompanied by an improvement in microvascular perfusion. This loss of “hemodynamic coherence,” i.e., the concordance between the response of the macrocirculation and the microcirculation, advocates for the integration of microvascular monitoring in the management of septic patients. Nonetheless, important barriers remain for a widespread use of sublingual videomicroscopy in the clinical practice. In this review, we discuss the actual limitations of this technique and future developments that may allow an easier and faster evaluation of the microcirculation at the bedside, and propose a role for sublingual microvascular monitoring in guiding and titrating resuscitative therapies in sepsis. |
| first_indexed | 2024-03-13T01:17:36Z |
| format | Article |
| id | doaj.art-7c3996c35c404a7f93fae1e3309edee4 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-13T01:17:36Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-7c3996c35c404a7f93fae1e3309edee42023-07-05T08:41:16ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-07-011010.3389/fmed.2023.12123211212321Microcirculation-guided resuscitation in sepsis: the next frontier?Elisa Damiani0Elisa Damiani1Andrea Carsetti2Andrea Carsetti3Erika Casarotta4Roberta Domizi5Claudia Scorcella6Abele Donati7Abele Donati8Erica Adrario9Erica Adrario10Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyDepartment of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, ItalyAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyDepartment of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, ItalyDepartment of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, ItalyAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyDepartment of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, ItalyAnesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, ItalyDepartment of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, ItalyMicrocirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during sepsis and are associated with poor outcome. More importantly, sublingual videomicroscopy allowed to explore the effects of commonly applied resuscitative treatments in septic shock, such as fluids, vasopressors and inotropes, and showed that the optimization of macro-hemodynamic parameters may not be accompanied by an improvement in microvascular perfusion. This loss of “hemodynamic coherence,” i.e., the concordance between the response of the macrocirculation and the microcirculation, advocates for the integration of microvascular monitoring in the management of septic patients. Nonetheless, important barriers remain for a widespread use of sublingual videomicroscopy in the clinical practice. In this review, we discuss the actual limitations of this technique and future developments that may allow an easier and faster evaluation of the microcirculation at the bedside, and propose a role for sublingual microvascular monitoring in guiding and titrating resuscitative therapies in sepsis.https://www.frontiersin.org/articles/10.3389/fmed.2023.1212321/fullsepsisseptic shockmicrocirculationsublingual videomicroscopytissue perfusionglycocalyx |
| spellingShingle | Elisa Damiani Elisa Damiani Andrea Carsetti Andrea Carsetti Erika Casarotta Roberta Domizi Claudia Scorcella Abele Donati Abele Donati Erica Adrario Erica Adrario Microcirculation-guided resuscitation in sepsis: the next frontier? Frontiers in Medicine sepsis septic shock microcirculation sublingual videomicroscopy tissue perfusion glycocalyx |
| title | Microcirculation-guided resuscitation in sepsis: the next frontier? |
| title_full | Microcirculation-guided resuscitation in sepsis: the next frontier? |
| title_fullStr | Microcirculation-guided resuscitation in sepsis: the next frontier? |
| title_full_unstemmed | Microcirculation-guided resuscitation in sepsis: the next frontier? |
| title_short | Microcirculation-guided resuscitation in sepsis: the next frontier? |
| title_sort | microcirculation guided resuscitation in sepsis the next frontier |
| topic | sepsis septic shock microcirculation sublingual videomicroscopy tissue perfusion glycocalyx |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1212321/full |
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