title: What is microcirculatory shock?
abstract: OBJECTIVE
  Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. In this article, we discuss the characteristics of the microcirculation in septic shock, the main form of microcirculatory shock, along with its interaction with systemic hemodynamics, and the response to different therapies.
  
  
  RESULTS
  In septic shock, microcirculatory abnormalities are common, and more severe in nonsurvivors. In addition, the microcirculation shows a behavior that is frequently dissociated from that of systemic hemodynamics. Therefore, microcirculatory alterations may persist despite correction of systemic hemodynamic variables. Sublingual and intestinal microcirculation might also display divergent behaviors. Moreover, microvascular alterations may improve in response to hemodynamic resuscitation, but the response might depend on the underlying microcirculatory alterations. Particularly, the response to fluids seems to be related to both its basal state and the magnitude of the increase in cardiac output.
  
  
  CONCLUSIONS
  The optimal treatment of microcirculatory shock might require monitoring and therapeutic goals targeted on the microcirculation, more than in systemic variables. The clinical benefits of this approach should be demonstrated in clinical trials.
authors.affiliation: aAcademic Medical Center, Department of Translational Physiology, University of Amsterdam, Amsterdam, Netherlands bFacultad de Ciencias Médicas, Universidad Nacional de La Plata, Cátedra de Farmacología Aplicada, La Plata cSanatorio Otamendi y Miroli, Servicio de Terapia Intensiva, Buenos Aires, Argentina.
authors.forename: Vanina S
authors.initials: VS
authors.lastname: Kanoore Edul
authors.forename: Can
authors.initials: C
authors.lastname: Ince
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Dubin
mesh_terms: D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D012039:Regional Blood Flow; D012151:Resuscitation; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*