Document Type : Short Communication

Authors

1 Intensive Care Unit. Hospital Hermanos Ameijeiras, La Habana, Cuba.

2 Centro de Investigaciones Medico Quirurgicas, La Habana, Cuba.

Abstract

Perfusion is a continuous and regulated physiological process of distribution of blood volume per unit of time and weight of tissue to guarantee energy requirements. Traditionally, perfusion was evaluated by monitoring systemic variables (macrocirculation), which constituted a limitation given its regional character with heterogeneous distribution according to particular needs of the different regions of the organism, through a micro vascular network (microcirculation). In the present communication highlight the need for systemic perfusion monitoring through macro and microcirculation variables together with monitoring of dependent organ variables to establish an accurate diagnosis of the patient's situation and especially to direct therapeutic actions. The peculiar characteristics of cerebral perfusion make CBF monitoring mandatory along with cerebral metabolic monitoring.

Graphical Abstract

Relationship between Systemic and Cerebral Perfusion in Neurocritical Patients

Keywords

Main Subjects

1.            Stens J, de Wolf SP, van der Zwan RJ, et al.    Microcirculatory perfusion during different perioperative hemodynamic strategies. Microcirculation. 2015; 22(4): 267-75.

[crossref]

2.            Rivers EP, Yataco AC, Jaehne AK, Gill J, Disselkamp M. Oxygen extraction and perfusion markers in severe sepsis and septic shock: diagnostic, therapeutic and outcome implications. Curr Opin Crit Care. 2015; 21(5): 381-7. [crossref]

3.            Kazune S, Caica A, Luksevics E, Volceka K, Grabovskis A. Impact of increased mean arterial pressure on skin microcirculatory oxygenation in vasopressor-requiring septic patients: an interventional study. Ann Intensive Care. 2019; 9(1): 97. [crossref]

4.            Pouska J, Tegl V, Astapenko D, Cerny V, Lehmann C, Benes J. Impact of Intravenous Fluid Challenge Infusion Time on Macrocirculation and Endothelial Glycocalyx in Surgical and Critically Ill Patients. Biomed Res Int. 2018; 2018: 1-11. [crossref]

5.            Catchlove SJ, Macpherson H, Hughes ME, Chen Y, Parrish TB, Pipingas A. An investigation of cerebral oxygen utilization, blood flow and

 cognition in healthy aging. PLoS One. 2018; 13(5): e0197055. [crossref]

6.            Kirkman MA, Smith M. Brain Oxygenation Monitoring. AnesthesiolClin. 2016; 34(3): 537-56. [crossref]

7.            Czosnyka M. In a Search of Pressure Which Optimizes Autoregulation of Cerebral Blood Flow. Crit Care Med. 2019; 47(10): 1472-1473.

[crossref]

8.            Minhas JS, Panerai RB, Swienton D, Robinson TG. Feasibility of improving cerebral autoregulation in acute intracerebral hemorrhage (BREATHE-ICH) study: Results from an experimental interventional study. Int J Stroke. 2019; 9: 174. [crossref]

9.            Zampieri FG, Damiani LP, Bakker J, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: a bayesian reanalysis of the andromeda-shock trial. Am J Respir Crit Care Med. 2019; 321(7):654-664. [crossref] 

10.          Wijntjens GW, Fengler K, Fuernau G, et al. Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy. Eur Heart J Acute Cardiovasc Care. 2019; 13: 1-12. [crossref]