© 2018

Monitoring Tissue Perfusion in Shock

From Physiology to the Bedside

  • Alexandre Augusto Pinto Lima
  • Eliézer Silva


  • Shows the benefit of monitoring tissue oxygenation as a point-of-care test using noninvasive methods

  • Demonstrates how evaluation of regional tissue oxygenation at the bedside is feasible and reproducible

  • Represents an easy-to-use resource for the ICU team and other clinicians


Table of contents

  1. Front Matter
    Pages i-viii
  2. Introduction

    1. Front Matter
      Pages 1-1
    2. Glenn Hernández, Lara Rosenthal, Jan Bakker
      Pages 3-12
  3. Principles of Oxygen Transport and Consumption

    1. Front Matter
      Pages 13-13
    2. Ricardo Castro, Glenn Hernández, Jan Bakker
      Pages 15-23
    3. David Berlin, Vivek Moitra, Jan Bakker
      Pages 25-34
    4. Adriano José Pereira, Eliézer Silva
      Pages 35-48
  4. Measuring Tissue perfusion: Systemic Assessment

    1. Front Matter
      Pages 49-49
    2. Loek P. B. Meijs, Alexander J. G. H. Bindels, Jan Bakker, Michael R. Pinsky
      Pages 51-76
    3. Arnaldo Dubin, Eliézer Silva
      Pages 77-92
    4. Xavier Monnet, Jean-Louis Teboul
      Pages 121-130
    5. Glenn Hernández Poblete, Maarten W. Nijsten, Jan Bakker
      Pages 131-142
  5. Measuring Tissue Perfusion: Regional Assessment

    1. Front Matter
      Pages 143-143
    2. Roberto Rabello Filho, Thiago Domingos Corrêa
      Pages 145-151
    3. Alexandre Augusto Pinto Lima, Daniel De Backer
      Pages 153-171
    4. Diego Orbegozo-Cortès, Daniel De Backer
      Pages 173-180
    5. Jihad Mallat, Benoit Vallet
      Pages 181-192

About this book


This book describes various aspects of the basic physiological processes critical to tissue perfusion and cellular oxygenation, including the roles of the circulatory system, respiratory system, blood flow distribution and microcirculation.

In the context of monitoring critically ill patients in the early hours of circulatory shock, it is essential to recognize changes in traditional parameters such as mean arterial pressure and cardiac output, and to assess the need for active intervention. However, even if global macrocirculatory variables are restored, abnormalities in tissue oxygenation may persist. Tissue hypoperfusion is connected to the development of organ failure and, if it goes unrecognized, may worsen the prognosis. As a result, there is a growing interest in methods for monitoring regional perfusion in peripheral tissues to predict or diagnose ongoing hypoperfusion.

In this work, eminent experts from a range of disciplines convey a working knowledge of how regional monitoring in shock can complement the conventional global parameters of oxygen transport, and demonstrate that real-time bedside assessment of tissue oxygenation is readily achievable using noninvasive monitoring techniques. Accordingly, the book offers a valuable, easy-to-use guide for the entire ICU team and other clinicians.


Critically Ill Hypoxia Microcirculation Peripherall Perfusion Shock Tissue Oxygenation

Editors and affiliations

  • Alexandre Augusto Pinto Lima
    • 1
  • Eliézer Silva
    • 2
  1. 1.Department of Intensive CareErasmus MC University Hospital RotterdamRotterdamThe Netherlands
  2. 2.Medical School Hospital of the Albert EinsteinSao PauloBrazil

About the editors

Alexandre Augusto Pinto Lima obtained his medical degree from Faculdade de Ciências Médicas de Santos, São Paulo, Brazil, in 1996. After an internship and residency in tropical infectious diseases and HIV medicine at Instituto de Infectologia Hospital Emilio Ribas, Universidade de São Paulo in 1999, he entered clinical training in clinical infectious diseases at the Division of Intensive Care Unit, Hospital Sírio Libanês, São Paulo. He then served as an assistant medical doctor in the Department of Infectious Diseases and Critical Care Medicine, Universidade de São Paulo, and the Department of Intensive Care Medicine, Hospital do Servidor Publico Estadual, São Paulo. Dr. Lima joined the circulation research group at Adult Intensive Care, Erasmus University Medical Center Rotterdam in 2005. There he gained his PhD under the supervision of Prof. Jan Bakker. His field of study is hemodynamic circulation, with emphasis on optical methods for measuring tissue oxygenation.

Bibliographic information

Industry Sectors
Health & Hospitals
Internal Medicine & Dermatology


“The book highlights the fact that clinicians cannot improve microcirculation despite all their efforts to correct the macrocirculation. I recommend buying this book: it is a compilation of what is currently known about microcirculation and allows the reader to understand its importance.” (Yesim Cokay Abut, Anestesia & Analgesia, Vol. 128 (6), June, 2019)