Clinical monitoring of peripheral perfusion: perspective on ProCess.

摘要: We read with interest the commentary by Lima and Bakker [1]. The authors note that there are two phases in shock state differ degree of uncoupling macrocirculatory microcirculatory function. They suggest a shift to flow-based resuscitation may offer benefit for critically ill prioritising perfusion. This is particular when viewed context ProCess [2], recent negative early goal-directed therapy study. The absence treatment effect this trial from therapies one would normally expect resuscitate microcirculation warrants consideration. Resuscitation attempts reverse dysfunction appear clinical [3]. Conversely, phase established primary function be limiting damage preventing spread infection [4] harmful excess oxygen delivery parallel mitochondrial shutdown reduced consumption [5]. Microcirculatory organ failure therefore fact adaptive. Re-recruitment as result zealous could hence predicted detrimental tissue effects. utilised aggressive strategies, without an endpoint reflected perfusion ongoing metabolic need. successful some patients harm others, dependent on their individual illness. We caution despite results trial, concept should not yet discounted, but revisited once valid measures available.