The future of intensive care: the study of the microcirculation will help to guide our therapies

被引:47
作者
Duranteau, J. [1 ]
De Backer, D. [2 ]
Donadello, K. [3 ]
Shapiro, N. I. [4 ]
Hutchings, S. D. [5 ,6 ]
Rovas, A. [7 ]
Legrand, M. [8 ]
Harrois, A. [1 ]
Ince, C. [9 ]
机构
[1] Paris Saclay Univ, Bicetre Hosp, AP HP, INSERM,UMR S 999,Dept Anesthesiol & Intens Care, Le Kremlin Bicetre, France
[2] Univ Libre Bruxelles, CHIREC Hosp, Dept Intens Care, Blvd Triomphe 201, B-1160 Brussels, Belgium
[3] Univ Verona, Univ Hosp Integrated Trust Verona, Dept Surg Dentistry Paediat & Gynaecol, Anaesthesia & Intens Care Unit B, Verona, Italy
[4] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA USA
[5] Kings Coll Hosp NHS Fdn Trust, London, England
[6] Royal Ctr Def Med, Acad Dept Mil Anaesthesia & Crit Care, Birmingham, England
[7] Univ Hosp Munster, Dept Med D, Div Gen Internal & Emergency Med Nephrol & Rheumat, Albert Schweitzer Campus 1, D-48149 Munster, Germany
[8] UCSF, Dept Anesthesia & Perioperat Care, Div Crit Care Med, San Francisco, CA USA
[9] Univ Med Ctr, Dept Intens Care, Erasmus MC, Rotterdam, Netherlands
关键词
Hemodynamic resuscitation; Microcirculation; ICU; Hand-held vital microscopes; Artificial intelligence; MICROVASCULAR BLOOD-FLOW; SEVERE SEPSIS; SUBLINGUAL MICROCIRCULATION; SEPTIC SHOCK; IN-VIVO; ANTITHROMBIN; ASCORBATE; PERFUSION; TIME; PERMEABILITY;
D O I
10.1186/s13054-023-04474-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients.
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页数:13
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