CARDIOPULMONARY MONITORING: Edited by Jan BakkerMonitoring coherence between the macro and microcirculation in septic shockBakker, Jana,b,c,d; Ince, CanaAuthor Information aDepartment of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands bDepartment of Pulmonary and Critical Care, New York University School of Medicine cDivision of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA dDepartment of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile Correspondence to Jan Bakker, MD, PhD, FCCM, FCCP, Department of Intensive Care Adults, Erasmus MC University Medical Center, PO Box 2040, Room Ne-415, 3000 CA Rotterdam, The Netherlands. Tel: +31 10 7030772; e-mail: [email protected] Current Opinion in Critical Care: June 2020 - Volume 26 - Issue 3 - p 267-272 doi: 10.1097/MCC.0000000000000729 Buy Metrics Abstract Purpose of review Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. Recent findings Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the restoration of adequate macrocirculatory parameters is frequently not associated with improvement in microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences between different forms of shock, but also to the type of treatment. Summary The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation leading to increased morbidity and mortality. In this article the principles of coherence and the monitoring of the microcirculation are reviewed. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.