title: Haemodynamic coherence in haemorrhagic shock.
abstract: In case of haemorrhage, a combination of low volume fluid resuscitation and permissive hypotension is used to avoid the adverse effects of early aggressive fluid resuscitation. During this phase, occult microvascular hypoperfusion can possibly develop over time. After controlling the bleeding, it is expected that optimization of macrocirculation will result in an improvement in microcirculation. However, this is the case only without alterations in microcirculation regulation. Haemodynamic coherence must be maintained to expect the restoration of microcirculation through systemic haemodynamic-driven resuscitation. However, haemorrhagic shock, reperfusion, traumatic injury and inflammation can damage microcirculation and thus lead to a loss of haemodynamic coherence. In these cases, a systemic haemodynamic-driven resuscitation would not be effective in restoring microcirculation and tissue oxygenation. A real-time technique enabling microcirculation monitoring can create an opportunity for microcirculatory haemodynamic-driven resuscitation to become the gold standard in the future.
authors.affiliation: Laboratoire d'Etude de la Microcirculation, UMR 942, Université Paris, 7-11-13, Paris, France; Service d'Anesthésie-Réanimation, Hôpital d'instruction des armées Percy, Clamart, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Libert
authors.affiliation: Laboratoire d'Etude de la Microcirculation, UMR 942, Université Paris, 7-11-13, Paris, France; Service d'Anesthésie-Réanimation Chirurgicale, UMR 942, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
authors.forename: Anatole
authors.initials: A
authors.lastname: Harrois
authors.affiliation: Laboratoire d'Etude de la Microcirculation, UMR 942, Université Paris, 7-11-13, Paris, France; Service d'Anesthésie-Réanimation Chirurgicale, UMR 942, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France. Electronic address: jacques.duranteau@aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
mesh_terms: D006439:Hemodynamics; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000503:physiopathology* / Q000628:therapy
keywords: haemodynamic coherence; haemorrhage; microcirculation; microcirculatory haemodynamic-driven resuscitation