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Coupling microcirculation to systemic hemodynamics

De Backer, Daniel; Ortiz, Julian A; Salgado, Diamantino

Current Opinion in Critical Care: June 2010 - Volume 16 - Issue 3 - p 250–254
doi: 10.1097/MCC.0b013e3283383621
Cardiopulmonary monitoring: Edited by Michael R. Pinsky

Purpose of review: To discuss the role of microcirculatory abnormalities in critically ill patients and the link between systemic hemodynamics and microvascular perfusion.

Recent findings: Microcirculatory alterations have been repeatedly observed in patients with severe sepsis, but recent findings show that these also occur in patients with severe heart failure and in those submitted to high-risk surgery. More severe and more persistent alterations are observed in patients with a poor outcome. Even though a minimal cardiac output and arterial pressure is mandatory to sustain the microcirculation, this level is not yet well defined and seems to be submitted to high individual variability. Above this level, microcirculation and systemic circulation are relatively dissociated, so that microcirculatory alterations can be observed even when systemic hemodynamics are within satisfactory goals. In addition, the response of the microcirculation to therapeutic interventions is often dissociated from systemic effects. However, microcirculatory perfusion can be affected by cardiac output and arterial pressure when these are critically altered.

Summary: Microvascular alterations frequently occur in critically ill patients and these may be implicated in the development of organ failure and are associated with outcome. The link between systemic hemodynamics and microcirculation is relatively loose.

Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

Correspondence to Dr Daniel De Backer, Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium Tel: +32 2 555 3380; fax: +32 2 555 4698; e-mail: ddebacke@ulb.ac.be

© 2010 Lippincott Williams & Wilkins, Inc.