MICROCIRCULATION IN CRITICAL CARE: CURRENT PATHOPHYSIOLOGY AND PLACE IN THE STRATEGY OF MONITORING CRITICAL CONDITIONS AS A MONITORING TECHNOLOGY

Highlights

• This literature review covers classical and modern concepts of the pathophysiology of microcirculation, the disorders of which underlie most critical conditions. Such complications can develop in patients after various surgical interventions and lead to the development of multiple organ failure, which still has many unresolved problems in its treatment.
• The development of a standard for monitoring microcirculatory and mitochondrial dysfunction will improve the outcomes of critical patients and prevent organ hypoperfusion in the perioperative period and during treatment in intensive care units.

Abstract

The most important problem of intensive care measures for patients in the intensive care unit/operating room with the development of a systemic inflammatory reaction (associated with both aggressive surgery and shock, ischemia and reperfusion) is the obvious lack of effective clinical and laboratory diagnostic tools for the deterioration of microcirculation in organs and tissues (peripheral hypoperfusion). It is worth noting that the diagnosis and therapy of macrohemodynamic disorders that have already occurred does not guarantee improved microcirculation and sufficient relief of organ hypoxia, which is confirmed by current trends in maintaining high mortality rates in critical patients with shock and multiple organ failure. Therefore, it is necessary to develop new tools and strategies adapted to clinical use for the direct diagnosis of microcirculatory disorders in order to predict the development of multiple organ failure and timely targeted therapy. This review reveals in detail the main aspects of the etiology and pathogenesis of microcirculation disorders in critical conditions, the pathophysiology of the mechanisms of microcirculatory dysfunction, as well as the possible role of promising instrumental technologies for direct monitoring of microcirculation changes at the patient’s bedside. Taking into account the versatility and interrelation of the processes occurring in violation of microcirculatory hemodynamics and organ perfusion, the urgent need for the introduction of a clinically effective method of diagnosis and prognosis of the development of multiple organ failure in patients at risk for early and informed correction of therapeutic actions is emphasized. The review examines the potential methods of vital video microscopy and optical coherence tomography angiography for clinical use, their advantages and disadvantages for solving the problems of bedside direct diagnosis of microcirculatory dysfunction.

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