title: Review article: Part two: Goal-directed resuscitation--which goals? Perfusion targets.
abstract: Haemodynamic targets, such as cardiac output, mean arterial blood pressure and central venous oxygen saturations, remain crude predictors of tissue perfusion and oxygen supply at a cellular level. Shocked patients may appear adequately resuscitated based on normalization of global vital signs, yet they are still experiencing occult hypoperfusion. If targeted resuscitation is employed, appropriate use of end-points is critical. In this review, we consider the value of directing resuscitation at the microcirculation or cellular level. Current technologies available include sublingual capnometry, video microscopy of the microcirculation and near-infrared spectroscopy providing a measure of tissue oxygenation, whereas base deficit and lactate potentially provide a surrogate measure of the adequacy of global perfusion. The methodology and evidence for these technologies guiding resuscitation are considered in this narrative review.
authors.affiliation: Departments of Intensive Care Medicine Emergency Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia. anthony_holley@health.qld.gov.au
authors.forename: Anthony
authors.initials: A
authors.lastname: Holley
authors.forename: William
authors.initials: W
authors.lastname: Lukin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
authors.forename: Tracey
authors.initials: T
authors.lastname: Hawkins
authors.forename: Robert
authors.initials: R
authors.lastname: Boots
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D006801:Humans; D009937:Organizational Objectives; D010477:Perfusion / Q000592:standards*; D012151:Resuscitation / Q000379:methods*