EXPERT OPINION ON THE STUDY OF MICROCIRCULATION IN CRITICAL CONDITIONS

The study of microcirculation and the adoption of therapeutic decisions to correct microcirculatory distress with the restoration of hemodynamic coherence is one of the promising areas of intensive therapy for multiple organ failure, especially during the transition from the acute critical phase to the phase at risk of developing MODS.
Despite the development of a number of microcirculation monitoring technologies, primarily in terms of direct visualization of microcirculation, most monitoring methods have not become part of real clinical practice.
During the 27th All‑Russian Conference with international participation “Life Support in Critical Conditions,” which took place in Moscow on November 7–8, 2025, and the roundtable on the topic “Monitoring the microcirculation of critically ill patients: the first steps of our own technologies,” a number of Russian research teams presented developments at various levels of technology readiness, which can be considered as candidates for further research and implementation in real practice. From the perspective of clinical feasibility and the evidence base, the demand for these technologies should be assessed taking into account the market situation and the prospects for commercialization.
The roundtable participants presented their developments. At the same time, they noted the common problems characteristic of all the technologies under consideration. As with technologies known as the “gold standard”—in particular, direct visualization of microcirculation via manual video microscopy—most microcirculation monitoring methods lack standardized characteristics of the parameters under study according to SMART criteria:
• S (Specific) — a specific indicator clearly defined to address a specific clinical problem;
• M (Measurable) – clear units of measurement, clear cut‑off values (cut‑off values), diagnostic threshold, predictive threshold, target value;
• A (Achievable) – test availability, analysis time, cost, ease of implementation;
• R (Relevant) – the indicator must address an important clinical problem that affects the patient management strategy and outcome;
• T (Time‑bound) – defined timeframes for measuring the parameter and interpreting the results obtained.
It is projected that the market volume for hemodynamic monitors will grow from USD 1.8 billion in 2020 to USD 3 billion or more by 2025–2026. The main trend will be a shift towards less invasive, high‑tech, and user‑friendly systems that can be integrated into the infrastructure of medical information systems.
Integrating microcirculation monitoring into existing hemodynamic systems will make it possible to bring microvascular monitoring to the point of care in real time. This will make it possible to personalize therapy and improve outcomes in patients with multiple organ failure.