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

J. Duranteau*, D. De Backer, K. Donadello, N. I. Shapiro, S. D. Hutchings, A. Rovas, M. Legrand, A. Harrois, C. Ince

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

19 Citations (Scopus)
19 Downloads (Pure)

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.

Original languageEnglish
Article number190
JournalCritical Care
Volume27
Issue number1
DOIs
Publication statusPublished - Dec 2016

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