Early diagnosis and optimal management of objective microcirculatory dysfunction to prevent the development of multiple organic dysfunction syndrome

Abstract

Microcirculatory dysfunction plays a central role in the genesis of multiple organ dysfunction syndrome (MODS), being a pathophysiological milestone of it. The mechanism of producing MODS is complex and still incompletely studied, having enough unknowns. It is now known that, despite adequate treatment of macrohemodynamics, there are few correlations between systemic hemodynamic improvement and correction of microcirculatory abnormalities, and the presence of these dysfunctions is more common among patients who do not survive than in survivors. Therapeutic intervention based on evaluation and demonstration of microcirculation dysfunction may help restore splanchnic infusion with definite benefit in selected patients. The method that evaluates in vivo, timely and non-invasive microvascularization is videocapillaroscopy. Although in the past, resuscitation measures were mostly geared towards systemic circulation, the future could be aimed at strategies to restore adequate microcirculation. Basically, the large-scale implementation of oral microcirculation exploration techniques for the diagnosis and monitoring of critical patients, candidates for the development of MODS in intensive care units is an absolute necessity. Being a non-invasive technique, microcirculation evaluation can be performed whenever needed for a diagnosis of certainty.