Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock
Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell; Type 2: Macro-Micro incoherence + normal cell; Type 3: Micro-Cell incoherence + normal Micro; and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.
|Keywords||Circulatory shock, Shock, Tissue perfusion, Microcirculation, Hemodynamic coherence, Resuscitation incoherence|
|Persistent URL||dx.doi.org/10.1097/cm9.0000000000000221, hdl.handle.net/1765/119366|
|Journal||Chinese Medical Journal|
He, H.W., Long, Y., Liu, D.W., & Ince, C. (2019). Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock. Chinese Medical Journal, 132(10), 1218–1227. doi:10.1097/cm9.0000000000000221