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
Affiliations
J. Duranteau
Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University
D. De Backer
Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles
K. Donadello
Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona
N. I. Shapiro
Department of Emergency Medicine, Beth Israel Deaconess Medical Center–Harvard Medical School
S. D. Hutchings
King’s College Hospital NHS Foundation Trust
A. Rovas
Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital Münster
M. Legrand
Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF
A. Harrois
Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University
C. Ince
Department of Intensive Care, Erasmus MC, University Medical Center
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.
