How microcirculation data have changed my clinical practice.
OBJECTIVE
The present review discusses how microcirculation assessment, which was recently made feasible, has altered clinical practice.


RESULTS
Experimental data have provided important information on microcirculation alterations in disease states. Recent advances in imaging techniques have allowed microcirculation studies in critically ill patients. Derangements in microcirculation are variable and unpredictable, associated with organ dysfunction and outcome, and can be improved by therapeutic interventions. Recent studies not only confirm the beneficial effects of some drugs on the microcirculation, but also suggest new mechanisms of actions of these drugs. In particular, the interaction between the endothelial surface and circulating cells, and especially white blood cells, seems to be crucial. Although these imaging techniques provide important information, these remain difficult to implement at the bedside. Assessment of vasoreactivity using transient occlusion tests and indirect measurements of microvascular blood flow with laser Doppler or near infrared spectroscopy may be good alternatives.


CONCLUSIONS
Microcirculation alterations are present in shock states, mainly septic shock, and can have a prognostic role and be the target of therapeutic interventions. To date, microcirculation analysis remains in the field of clinical investigation, but recently interesting clinical data have encouraged assessment of the microcirculation at the bedside.
Büchele
Gustavo Luiz
GL
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Ospina-Tascon
Gustavo Adolfo
GA
De Backer
Daniel
D
D000818:Animals; D002245:Carbon Dioxide / Q000378:metabolism; D006801:Humans; D008833:Microcirculation; D010818:Practice Patterns, Physicians'; D019265:Spectroscopy, Near-Infrared; D018608:Ultrasonography, Doppler
D002245:Carbon Dioxide