BEDSIDE ASSESSMENT AND MANAGEMENT OF MICROCIRCULATION IN SEPTIC SHOCK

Abstract

Abnormalities of microcirculation in septic shock is one of the highlighted features of the condition. Tissue hypoperfusion and inadequate oxygen delivery at the cellular levels contributes to an oxygen debt and the multi-organ dysfunction seen in this condition. Clinically, the tissue oxygen delivery is manipulated using a combination of fluids, vasopressors and inotropes and this is measured using stroke volume, cardiac output and mean arterial pressure. These parameters indicate the oxygen delivery to the tissues. The downstream parameters including the centra venous oxygen saturation and the mixed venous oxygen saturation indicates the oxygen content of the venous blood. The difference between the two is assumed to be consumed by the tissues. However, in sepsis this may be an oversimplification of the situation. In such situations, bedside evaluation of the microcirculation becomes important. Although some sophisticated evaluation techniques are available which is being used on experimental basis, bedside evaluation of the microcirculation is something that can be done in any intensive care unit. This is a narrative review of some of these simple bedside tests that can be used for assessment of the microcirculation.