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Review Article
- CPR/Resuscitation
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
- Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim
- Acute Crit Care. 2026;41(2):201-212. Published online May 28, 2026
- DOI: https://doi.org/10.4266/acc.003425
- 3,741 View
- 643 Download
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Abstract
PDF - Shock is a state of circulatory failure characterized by impaired tissue perfusion due to a mismatch between oxygen delivery and consumption. While macrocirculation serves as a conduit to sustain blood flow toward the microcirculatory networks, it is the microcirculation that ultimately ensures the delivery of oxygen and nutrients to maintain cellular and organ function. The maintenance of proper macrocirculation is essential, but it does not necessarily indicate adequate microcirculation or recovery from shock. Thus, assessment of the microcirculation is also required to confirm effective tissue oxygenation. A comprehensive evaluation of both circulatory levels is crucial for accurate diagnosis and prognostication in patients with shock. This review explores a diverse range of clinical, biochemical, and device-based indicators that reflect the perfusion status of patients in shock. By examining their physiological significance and clinical relevance, we aim to provide a comprehensive framework for the hemodynamic assessment of critically ill patients and support the use of multidimensional strategies in shock management.
Original Article
- Basic Science and Research
- Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model
- Christine Kang, Ah-Reum Cho, Hyeon Jeong Lee, Hyae Jin Kim, Eun-Jung Kim, Soeun Jeo, Jeong-Min Hong, Daehoan Moon
- Acute Crit Care. 2021;36(1):29-36. Published online February 26, 2021
- DOI: https://doi.org/10.4266/acc.2020.00969
- 11,558 View
- 166 Download
- 2 Web of Science
- 2 Crossref
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Abstract
PDF
Supplementary Material - Background
Despite the importance of microcirculation in organ function, monitoring microcirculation is not a routine practice. With developments in microscopic technology, incident dark field (IDF) microscopy (Cytocam) has allowed visualization of the microcirculation. Dorsal skinfold chamber (DSC) mouse model has been used to investigate microcirculation physiology. By employing Cytocam-IDF imaging with DSC model to assess microcirculatory alteration in lipopolysaccharide (LPS)-induced endotoxemia, we attempted to validate availability of Cytocam-IDF imaging of microcirculation.
Methods
DSC was implanted in eight BALB/c mice for each group; control and sepsis. Both groups were given 72 hours to recover from surgery. The sepsis group had an additional 24-hour period of recovery post-LPS injection (4 mg/kg). Subsequently, a video of the microcirculation was recorded using Cytocam. Data on microcirculatory variables were obtained. Electron microscopy was implemented using lanthanum fixation to detect endothelial glycocalyx degradation.
Results
The microcirculatory flow index was significantly lower (control, 2.8±0.3; sepsis, 2.1±0.8; P=0.033) and heterogeneity index was considerably higher (control, 0.10±0.15; sepsis, 0.53±0.48; P=0.044) in the sepsis group than in the control group. Electron microscopy revealed glycocalyx demolishment in the sepsis group.
Conclusions
Cytocam showed reliable ability for observing changes in the microcirculation under septic conditions in the DSC model. The convenience and good imaging quality and the automatic analysis software available for Cytocam-IDF imaging, along with the ability to perform real-time in vivo experiments in the DSC model, are expected to be helpful in future microcirculation investigations. -
Citations
Citations to this article as recorded by
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim
Acute and Critical Care.2026; 41(2): 201. CrossRef - Sedation with propofol and isoflurane differs in terms of microcirculatory parameters: A randomized animal study using dorsal skinfold chamber mouse model
Christine Kang, Ah-Reum Cho, Haekyu Kim, Jae-Young Kwon, Hyeon Jeong Lee, Eunsoo Kim
Microvascular Research.2024; 153: 104655. CrossRef
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
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