Good Morning

   This week we discuss an article discussing the role of microcirculatory dysfunction in traumatic hemorrhage 

Although microcirculation is a focal point in most discussions on sepsis, its role in other forms of shock is discussed less often.

Microcirculatory Impairment Is Associated With Multiple Organ Dysfunction Following Traumatic Hemorrhagic Shock: The MICROSHOCK Study

Hutchings et al CCM JUNE 27 2018.

                   This study carried out in three major trauma centres in the UK attempted to study the pattern of microcirculatory dysfunction in traumatic hemorrhage and tried to identify a threshold for the prediction of MODS. The time points of interest were Day 0 ( within 12 hrs of hemostasis) D0 + 24 hrs and D0 + 48 hrs. Hyperlactatemia and invasive ventilatory support were part of the inclusion criteria. Incident Dark Field Videomicroscopy was used for assessment of the sublingual microcirculation. Cardiac output was measured using oesophageal doppler. 

                  The main findings seem to suggest that microcirculatory parameters like Total Vessel Density, Perfused Vessel Density and Microcirculatory flow index showed better ROC values for predicting worsening SOFA scores than Cardiac index. Systolic Blood pressure showed the least ROC characteristics. Perfused Vessel Density showed the best discriminatory ability. This discriminatory ability persisted throughout all time points of interest.

What I learnt from the study?

1. Shock is a unique pathophysiological state irrespective of etiology

2. Microcirculatory derangements probably occur before microcirculatory changes

3. Targeting systolic blood pressure alone may delay attention to tissue hypoperfusion

4. Assessment of microcirculation may become standard of care in future