Could resuscitation be based on microcirculation data? No

Excerpt

In modern medical practice, shock resuscitation is usually targeted towards the restoration of conventional parameters, such as those based on blood pressure, acid/base indicators, and partial pressures of gases. Since these are only surrogate markers of shock, it is appealing to consider the addition of microcirculation data to better inform the physician about the true behaviour of the interface at which shock is most relevant. Recent advances in technology that allow for the acquisition of microcirculatory data, such as transcutaneous oximetry, near-infrared spectroscopy (NIRS), and non-invasive handheld video-microscopy (HVM), make this a tantalising prospect [1]. However, technologies to monitor the microcirculation have been used within the research domain for decades without being adopted into clinical practice. Although some investigators have proposed mechanisms to obtain bedside point-of-care microcirculation data [2‐4], these techniques have been controversial, and their uptake slow. In order for microcirculation data to be useful for the resuscitation of patients, data must be easy to acquire at the bedside; easily interpreted, with universal understanding of parameters between clinicians; and must be useful as a target for goal-directed therapy or incorporation into diagnostic criteria. Furthermore, there would need to be widespread adoption of practice, with consensus regarding the utility of microcirculation data. Each of these criteria presents challenges that have the potential to stymie the practice of microcirculatory monitoring before it ever benefits clinical practice. …