Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill--where do we stand?
Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill--where do we stand?
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DOI：
10.1186/cc11236
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发表时间：
2012-06-19
期刊：
影响因子：
--
通讯作者：
Ince C
中科院分区：
文献类型：
--
作者：
Bezemer R;Bartels SA;Bakker J;Ince C
越来越多的证据表明，在广泛的临床情况下，微循环功能低下与发病率和死亡率有关。已经提出，使用液体和/或血液与血管活性剂组合以调节大血管和微血管灌注的容量替代疗法对于严重脓毒症患者的复苏可能是必不可少的。然而，即使在有效优化大循环血液动力学的干预之后，危重病患者，特别是脓毒症患者的高死亡率仍然存在。因此，与其将治疗仅限于大循环靶点，还可以结合微循环靶点，以潜在降低这些危重患者的死亡率。在本综述中，我们首先提供了一个简短的历史，临床微循环成像和描述如何微循环成像已在重症监护患者的预后价值。然后，我们给出了一个概述的治疗可能会改善危重患者的微循环，并提出了一项临床试验，旨在证明治疗靶向改善微循环的结果，改善器官功能的严重脓毒症和感染性休克患者。最后，我们在临床微循环图像采集和分析的一些最新技术进展。
A growing body of evidence exists associating depressed microcirculatory function and morbidity and mortality in a wide array of clinical scenarios. It has been suggested that volume replacement therapy using fluids and/or blood in combination with vasoactive agents to modulate macro- and microvascular perfusion might be essential for resuscitation of severely septic patients. Even after interventions effectively optimizing macrocirculatory hemodynamics, however, high mortality rates still persist in critically ill and especially in septic patients. Therefore, rather than limiting therapy to macrocirculatory targets alone, microcirculatory targets could be incorporated to potentially reduce mortality rates in these critically ill patients. In the present review we first provide a brief history of clinical imaging of the microcirculation and describe how microcirculatory imaging has been of prognostic value in intensive care patients. We then give an overview of therapies potentially improving the microcirculation in critically ill patients and propose a clinical trial aimed at demonstrating that therapy targeting improvement of the microcirculation results in improved organ function in patients with severe sepsis and septic shock. We end with some recent technological advances in clinical microcirculatory image acquisition and analysis.
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DOI：
10.1186/cc9220
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Jhanji S;Vivian-Smith A;Lucena-Amaro S;Watson D;Hinds CJ;Pearse RM
通讯作者：
Pearse RM
影响因子：
3.7
作者：
Dubin, Arnaldo;Pozo, Mario O;Ince, Can
通讯作者：
Ince, Can
影响因子：
3.8
作者：
Goedhart, P. T.;Khalilzada, M.;Ince, C.
通讯作者：
Ince, C.
影响因子：
8.8
作者：
Jhanji, Shaman;Stirling, Sarah;Pearse, Rupert M.
通讯作者：
Pearse, Rupert M.
影响因子：
8.8
作者：
de Backer, Daniel;Verdant, Colin;Vincent, Jean-Louis
通讯作者：
Vincent, Jean-Louis