The future of intensive care: the study of the microcirculation
will help to guide our therapies
by J. Duranteau, D.
De Backer, K. Donadello, N. I. Shapiro, S. D. Hutchings, A. Rovas, M. Legrand,
A. Harrois and C. Ince
Critical Care volume 27,
Article number: 190 Published: 16
May 2023
Abstract
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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