Relevance of Microvascular Flow Assessments in Critically Ill Neonates and Children: A Systematic Review.

Resolution of impaired microvascular flow may lag the normalization of macrocirculatory parameters. The significance of microcirculatory dysfunction in critically ill children and neonates is unknown, but microcirculatory variables can be measured using doppler or videomicroscopy imaging techniques. We outline the current understanding of the role of the microcirculation in critical illness, review methods for its assessment and perform a systematic review of how it has been monitored in critically ill neonates and children. Systematic review (PROSPERO CRD42019117993) N/A N/A None We systematically searched MEDLINE, EMBASE, PubMed and Web of Science. We included studies of critically ill patients 0 to 18 years old investigating microcirculatory blood flow. Two reviewers analyzed abstracts and articles. Results were qualitatively analyzed due to study heterogeneity. A total of 2559 abstracts met search criteria, of which 94 underwent full text review. Of those, 36 met inclusion criteria. Seven studies investigated microcirculatory changes in critically ill children. Twenty studies investigated the microcirculatory changes in neonates with variable diagnoses compared to a diverse set of clinical end points. Nine studies assessed the effects of age, sex and birth weight on microvascular flow in neonates. Across all studies, microcirculatory dysfunction was associated with poor outcomes and may not correlate with observed macrovascular function. Assessment of microvascular flow in critically ill children and neonates is possible, though significant challenges remain. In many such patients, microvascular blood flow is disrupted despite medical management targeting normalized macrovascular parameters. Future studies are needed to define normal pediatric microvascular flow parameters and to assess the impact of patient and treatment factors on its function.

微血管血流受损的恢复可能滞后于大循环参数的正常化。危重症儿童和新生儿微循环功能障碍的意义尚不明确，但可使用多普勒或视频显微镜成像技术测量微循环变量。我们概述了目前对微循环在危重症中作用的理解，综述了其评估方法，并对危重症新生儿和儿童中如何监测微循环进行了系统综述。 系统综述（PROSPERO CRD42019117993） 无 无 无 我们系统地检索了MEDLINE、EMBASE、PubMed和Web of Science。我们纳入了对0至18岁危重症患者进行微循环血流研究的相关文献。两名综述者对摘要和文章进行了分析。由于研究的异质性，对结果进行了定性分析。 共有2559篇摘要符合检索标准，其中94篇进行了全文审查。在这些文献中，36篇符合纳入标准。7项研究调查了危重症儿童的微循环变化。20项研究调查了不同诊断的新生儿与多种临床终点相比的微循环变化。9项研究评估了年龄、性别和出生体重对新生儿微血管血流的影响。在所有研究中，微循环功能障碍与不良预后相关，且可能与观察到的大血管功能无关。 对危重症儿童和新生儿的微血管血流进行评估是可行的，但仍存在重大挑战。在许多此类患者中，尽管医疗干预以大血管参数正常化为目标，但微血管血流仍受到干扰。未来需要开展研究以确定儿童正常的微血管血流参数，并评估患者和治疗因素对其功能的影响。