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. 2019 May 20;132(10):1218-1227.
doi: 10.1097/CM9.0000000000000221.

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

Huai-Wu He  1 , Yun Long  1 , Da-Wei Liu  1 , Can Ince  2
Affiliations

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

Huai-Wu He et al. Chin Med J (Engl). .

Abstract

Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock.

Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro).

Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included.

Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell; Type 2: Macro-Micro incoherence + normal cell; Type 3: Micro-Cell incoherence + normal Micro; and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock.

Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.

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Figures

Figure 1
Figure 1
Schematic diagram to interpret P(v-a)CO2/C(a-v)O2 ratio in clinical practice. DO2: Oxygen delivery; P(v-a)CO2/C(a-v)O2: Central venous-arterial carbon dioxide difference/arterial-central venous oxygen difference; VO2: Oxygen consumption.
Figure 2
Figure 2
Schematic diagram of the classification of resuscitation incoherence.
Figure 3
Figure 3
Schematic diagram of the degree scale of dynamic circulation-perfusion coupling (CPC).
Figure 4
Figure 4
A conceptual protocol of the use of dynamic circulation-perfusion coupling (CPC) and resuscitation coherence loss. RI: Resuscitation incoherence.
See this image and copyright information in PMC

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