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Monitoring the Microcirculation in Critically Ill Patients

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Abstract

An increasing body of evidence exists emphasizing that microcirculatory alterations are associated with morbidity and mortality in a wide array of clinical scenarios. Despite efforts to optimize the balance between micro- and macrohemodynamics, high mortality rates still persist in the critically ill – especially with septic patients. The severity and persistence of microcirculatory abnormalities are believed to be directly associated with a poor prognosis in critically ill patients. In the present chapter, we review some of the techniques that have been used to monitor the microcirculation in critically ill patients. Handheld optical spectroscopic-based imaging instruments have been used extensively to clinically monitor and quantify perfusion abnormalities associated with profound microvascular perfusion heterogeneities. However, using these techniques to diagnose and guide resuscitation remains a challenge. Technological advances in microcirculatory image acquisition and analysis should provide a platform enabling microcirculation-targeted resuscitation by providing rapid clinical feedback on the efficacy of applied therapeutic strategies aimed at normalizing the microcirculation in critically ill patients. It is anticipated that more complete and personalized treatments based on resuscitation of the microcirculation will ultimately improve patient outcome in the near future as technology related to bedside microcirculatory monitoring progresses.

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Author information

Authors and Affiliations

  1. Department of Intensive Care, Mutua Terrassa University Hospital, Pl. Dr. Robert, 5Terrassa, Barcelona, 08221, Spain

    Eduardo Romay Medina MD

  2. Department of Oral and Maxillofacial Surgery, Academic Medical Center, Room M01-220, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands

    Dan M. J. Milstein PhD

  3. Department of Intensive Care Medicine, Erasmus M.C. University Hospital Rotterdam, ‘s-Gravendijkwal 230, Rotterdam, 3000, AC, The Netherlands

    Can Ince PhD

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  1. Eduardo Romay Medina MD
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  2. Dan M. J. Milstein PhD
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  3. Can Ince PhD
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Correspondence to Eduardo Romay Medina MD .

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Editors and Affiliations

  1. Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Jesse M. Ehrenfeld

  2. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California, USA

    Maxime Cannesson

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Medina, E.R., Milstein, D.M.J., Ince, C. (2014). Monitoring the Microcirculation in Critically Ill Patients. In: Ehrenfeld, J., Cannesson, M. (eds) Monitoring Technologies in Acute Care Environments. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8557-5_15

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  • DOI: https://doi.org/10.1007/978-1-4614-8557-5_15

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