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Evaluation of the Microcirculation in Critically Ill Patients

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Abstract

The first goal of therapies in critically ill patients is to improve tissue perfusion and oxygenation. Hemodynamic monitoring has long been limited to measurements of cardiac output and global oxygen delivery. The clinical introduction of hand-held vital microscopes in the late 1990s enabled the real-time, non-invasive, bedside observation of blood flow in the microcirculation (vessels with diameter <100 µm), i.e. the real site of oxygen and nutrient exchange between blood and cells. Microcirculatory alterations have been described during sepsis and shock states and were associated with mortality. These can occur independently of systemic hemodynamic alterations. Sublingual videomicroscopy allowed evaluating the microvascular response to resuscitation procedures, including oxygen therapy, fluids, blood transfusions, vasopressors. Future research directions should be aimed to integrate microcirculatory monitoring with standard hemodynamic measurements and verify the utility of microcirculation as a therapeutic target. Continuous technological developments are imperative to facilitate the introduction of sublingual videomicroscopy in the clinical practice.

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Authors and Affiliations

  1. Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, 60126, Ancona, Italy

    Elisa Damiani, Roberta Domizi, Claudia Scorcella, Andrea Carsetti & Abele Donati

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  1. Elisa Damiani
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  2. Roberta Domizi
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  3. Claudia Scorcella
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  4. Andrea Carsetti
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  5. Abele Donati
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Correspondence to Abele Donati .

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Editors and Affiliations

  1. Department of Information Engineering (DII), Marche Polytechnic University, Ancona, Italy

    Sauro Longhi

  2. Department of Information Engineering (DII), Marche Polytechnic University, Ancona, Italy

    Andrea Monteriù

  3. Department of Information Engineering (DII), Marche Polytechnic University, Ancona, Italy

    Alessandro Freddi

  4. Department of Agricultural, Food and Environmental Sciences (D3A), Marche Polytechnic University, Ancona, Italy

    Lucia Aquilanti

  5. Ospedali Riuniti di Ancona, Ancona, Italy

    Maria Gabriella Ceravolo

  6. Department of Life and Environmental Sciences (DISVA), Marche Polytechnic University, Ancona, Italy

    Oliana Carnevali

  7. Department of Life and Environmental Sciences (DISVA), Marche Polytechnic University, Ancona, Italy

    Mario Giordano

  8. Ospedali Riuniti di Ancona, Ancona, Italy

    Gianluca Moroncini

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Damiani, E., Domizi, R., Scorcella, C., Carsetti, A., Donati, A. (2020). Evaluation of the Microcirculation in Critically Ill Patients. In: Longhi, S., et al. The First Outstanding 50 Years of “Università Politecnica delle Marche”. Springer, Cham. https://doi.org/10.1007/978-3-030-33832-9_25

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