- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 640) Tissue perfusion monitoring in the ICU
- Chapter:
- (p. 640) Tissue perfusion monitoring in the ICU
- Author(s):
Eric Kipnis
and Benoit Vallet
- DOI:
- 10.1093/med/9780199600830.003.0138
Resuscitation endpoints have shifted away from restoring normal values of routinely assessed haemodynamic parameters (central venous pressure, mean arterial pressure, cardiac output) towards optimizing parameters that reflect adequate tissue perfusion. Tissue perfusion-based endpoints have changed outcomes, particularly in sepsis. Tissue perfusion can be explored by monitoring the end result of perfusion, namely tissue oxygenation, metabolic markers, and tissue blood flow. Tissue oxygenation can be directly monitored locally through invasive electrodes or non-invasively using light absorbance (pulse oximetry (SpO2) or tissue (StO2)). Global oxygenation may be monitored in blood, either intermittently through blood gas analysis, or continuously with specialized catheters. Central venous saturation (ScvO2) indirectly assesses tissue oxygenation as the net balance between global O2 delivery and uptake, decreasing when delivery does not meet demand. Lactate, a by-product of anaerobic glycolysis, increases when oxygenation is inadequate, and can be measured either globally in blood, or locally in tissues by microdialysis. Likewise, CO2 (a by-product of cellular respiration) and PCO2 can be measured globally in blood or locally in accessible mucosal tissues (sublingual, gastric) by capnography or tonometry. Increasing PCO2 gradients, either tissue-to-arterial or venous-to-arterial, are due to inadequate perfusion. Metabolically, the oxidoreductive status of mitochondria can be assessed locally through NADH fluorescence, which increases in situations of inadequate oxygenation/perfusion. Finally, local tissue blood flow may be measured by laser-Doppler or visualized through intravital microscopic imaging. These perfusion/oxygenation resuscitation endpoints are increasingly used and studied in critical care.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care