COUPLING OF MICRO- AND MACRO-CIRCULATION – RATIONALE FOR ADVANCED INSTRUMENTAL MONITORING IN CRITICALLY ILL PATIENTS: A SYSTEMATIC REVIEW

Highlights

• The main methods of assessing macrocirculation, such as invasive and noninvasive blood pressure, indicators of hemodynamics of the small circle of blood circulation, indicators of invasive measurement of cardiac contractility, used in daily practice to monitor the adequacy of systemic perfusion, represent only a small fraction of the actual state of macro- and microcirculation. The main trend in the development of monitoring is the assessment of the conjugacy of circulation at different levels – the conjugacy of micro- and macrocirculation. The possibility of using a combination of standard methods for assessing systemic blood flow and the availability of online methods for examining the state of the microvascular bed, as well as biochemical markers of the endothelial bed, makes it possible to approach intensive care more appropriately.

Abstract

Clinical recommendations for the intensive care of critical conditions are mainly based on the principles of correction of systemic hemodynamic parameters using infusion media, cardiotonic and vasopressor support. However, the effectiveness of this approach, apparently, requires further research of other pathogenetic therapies, since clinical studies conclude that successful restoration of macrohemodynamical parameters against the background of the use of conventional therapy regimens often does not lead to successful restoration of microcirculatory blood flow. Microcirculation disorders are the central link of pathological processes in the body. Popular methods for assessing the state of tissue microcirculation are represented exclusively by surrogate methods. They largely do not coincide with the actual state of microcirculation. The purpose of our review was to search for modern and affordable methods of direct observation and assessment of microcirculation (dark field microscopy, laser Doppler flowmeter, optical coherence tomography) and biochemical markers of endothelial dysfunction that allow us to move from simple implementation of trivial algorithms to the real beginning of personalized intensive therapy aimed at resolving tissue hypoxemia and resolving critical condition.

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