Background Microcirculatory dysfunction may persist despite restoration of conventional macrocirculatory targets in sepsis, reflecting loss of hemodynamic coherence. This review synthesizes current microcirculatory monitoring approaches according to the physiological information they provide and examines how complementary modalities may be integrated to characterize persistent or regional tissue hypoperfusion. Main body A narrative review of PubMed-indexed literature was conducted, with emphasis on bedside peripheral perfusion assessment, tissue oxygenation and superficial perfusion imaging, direct microvascular visualization, and organ- or tissue-specific monitoring. Recent studies were prioritized together with landmark methodological and validation studies. Available techniques interrogate distinct but overlapping components of the circulation. Bedside peripheral measures provide rapid information on skin reperfusion and vascular tone; spectroscopic and optical techniques characterize tissue oxygenation, reactivity, and spatial perfusion heterogeneity; direct microvascular imaging enables assessment of microvascular density and flow; and organ-specific approaches provide information on renal, cerebral, or retinal perfusion and oxygenation. Discordance between these domains may persist despite improvement in blood pressure or cardiac output, supporting serial multimodal rather than single-variable interpretation. However, substantial heterogeneity in acquisition protocols, measurement sites, devices, analytical methods, and proposed thresholds limits comparability and clinical implementation. Conclusion Microcirculatory monitoring should currently be viewed as a complementary framework for identifying persistent or heterogeneous tissue hypoperfusion beyond conventional macrocirculatory targets. Its integration into individualized resuscitation remains promising but requires standardized methodology, external validation, and prospective interventional evidence before any single modality or multimodal strategy can be adopted as a validated resuscitation endpoint.

A ministra da Saúde admitiu hoje que a falta de anestesiologistas constitui um “grande problema” em Lisboa e Vale do Tejo, que poderá ser resolvido com a partilha de recursos entre hospitais, no âmbito das futuras urgências centralizadas.

Background Supraventricular arrhythmias are frequent in critically ill patients and landiolol, an ultra-short-acting, highly β1-selective adrenergic blocker, is increasingly used for their management. Its efficacy and dosing have been described, but its early hemodynamic tolerance at the bedside — when intolerance occurs, how it presents, and which patients are at risk — remains poorly characterized, particularly in vasopressor-dependent patients under-represented in existing cohorts. We aimed to describe the hemodynamic tolerance of landiolol and to identify bedside predictors of poor tolerance. Methods We conducted a retrospective single-center study in patients admitted to the intensive care unit who received landiolol for supraventricular arrhythmia between January 2021 and February 2023. Hemodynamic variables, including pulse pressure, were recorded at baseline (H0) and at H1, H2, H4, H6 and H24. A hemodynamic adverse event was defined as a composite of mean arterial pressure below 64 mmHg, bradycardia below 50 bpm, or a more than 50% increase in vasopressor dose, counted only while landiolol was infused. Predictors of poor tolerance were identified by multivariable logistic regression. Results Among 133 patients (median age 68 years; SAPS II 51; sepsis 54.9%; vasopressors 49.6%), a hemodynamic adverse event occurred in 27 (20.3%), mostly within the first six hours. Events consisted of hypotension or vasopressor escalation; no patient developed bradycardia below 50 bpm. A lower diastolic pressure (adjusted OR 1.05 per 1-mmHg decrease, 95% CI 1.01–1.10) and vasopressor use at initiation (adjusted OR 3.00, 95% CI 1.14–7.91) were independently associated with poor tolerance. Heart rate control was achieved without deterioration of arterial pressure, pulse pressure, ventricular function, or tissue perfusion. Conversion to sinus rhythm was more frequent in new-onset than in pre-existing atrial fibrillation (54.4% vs. 27.9%; p = 0.004). Conclusion In critically ill patients, hemodynamic intolerance to landiolol occurred in one-fifth of cases, arose early, and took the form of hypotension or increased vasopressor requirements rather than bradycardia. A low diastolic pressure and vasopressor dependence identified patients at risk, supporting cautious, individualized use with close monitoring during early titration.

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Background:Ephedrine has been suggested to improve cerebral microcirculation and perfusion compared with phenylephrine. However, prospective...

Background:Ephedrine has been suggested to improve cerebral microcirculation and perfusion compared with phenylephrine. However, prospective...