It seems logical to divide the macrocirculation into systemic and pulmonary circulation, but it is rare in clinical practice to further subdivide microcirculation into systemic and pulmonary microcirculation. Both systemic and pulmonary microcirculations play important roles in the development and progression of critical illness. Therefore, targeting the overall microcirculation status for clinical treatment may overlook the heterogeneity of different critically ill patients. It seems unavoidable to further subdivide the microcirculation, so this review explains the differences in structure, function, blood flow regulation, and other important aspects between systemic and pulmonary microcirculation, systematically presenting the concept of “double microcirculation.” At the same time, to refine the critical care treatment and even improve the prognosis of critically ill patients, we further propose and explain the treatment key points based on “double microcirculation protection.”
ChalkiasALaouEMermiriM, et al.Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock. Eur J Trauma Emerg Surg. 2022;48(6):4699–4711.
8.
SchneiderCLHenryMM. Meconium embolism in vivo. Pulmonary and systemic microcirculation (as in maternal amniotic embolism). Am J Obstet Gynecol. 1968;101(7):909–914.
9.
DoerschukCMWinnRKCoxsonHOHarlanJM. CD18-dependent and -independent mechanisms of neutrophil emigration in the pulmonary and systemic microcirculation of rabbits. J Immunol. 1990;144(6):2327–2333.
10.
FeuerDSHandbergEMMehradB, et al.Microvascular dysfunction as a systemic disease: A review of the evidence. Am J Med. 2022;135(9):1059–1068.
11.
VlastosDZeinahMNinkovic-HallG, et al.The effects of ischaemic conditioning on lung ischaemia-reperfusion injury. Respir Res. 2022;23(1):351.
12.
De BackerDRicottilliFOspina-TasconGA. Septic shock: A microcirculation disease. Curr Opin Anaesthesiol. 2021;34(2):85–91.
13.
MerdjiHLevyBJungCInceCSiegemundMMezianiF. Microcirculatory dysfunction in cardiogenic shock. Ann Intensive Care. 2023;13(1):38.
14.
DomiziRDamianiEScorcellaC, et al.Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study. PLoS One. 2019;14(3):e0213085.
15.
LamCTymlKMartinCSibbaldW. Microvascular perfusion is impaired in a rat model of normotensive sepsis. J Clin Invest. 1994;94(5):2077–2083.
16.
EdulVSInceCVazquezAR, et al.Similar microcirculatory alterations in patients with normodynamic and hyperdynamic septic shock. Ann Am Thorac Soc. 2016;13(2):240–247.
17.
EdulVSFerraraGPozoMO, et al.Failure of nitroglycerin (glyceryl trinitrate) to improve villi hypoperfusion in endotoxaemic shock in sheep. Crit Care Resusc. 2011;13(4):252–261.
18.
EdulVSEnricoCLaviolleBVazquezARInceCDubinA. Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med. 2012;40(5):1443–1448.
19.
KoningNJSimonLEAsfarPBaufretonCBoerC. Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass. Am J Physiol Heart Circ Physiol. 2014;307(7):H967–H975.
20.
YamamotoMIshizuTSeoY, et al.Pathophysiological role of right ventricular function and interventricular functional mismatch in the development of pulmonary edema in acute heart failure. J Cardiol2022;79(6):711–718.
21.
JozwiakMTeboulJLMonnetX. Extravascular lung water in critical care: Recent advances and clinical applications. Ann Intensive Care. 2015;5(1):38.
22.
DullROCluffMKingstonJ, et al.Lung heparan sulfates modulate K(fc) during increased vascular pressure: Evidence for glycocalyx-mediated mechanotransduction. Am J Physiol Lung Cell Mol Physiol. 2012;302(9):L816–L828.
23.
PanPSuLXZhouXLongYLiuDWWangXT. Critical hemodynamic therapy oriented resuscitation helping reduce lung water production and improve survival. Chin Med J (Engl). 2019;132(10):1139–1146.
24.
YoshidaTNakahashiSNakamuraMAM, et al.Volume-controlled ventilation does not prevent injurious inflation during spontaneous effort. Am J Respir Crit Care Med2017;196(5):590–601.
25.
BellaniGGrasselliGTeggia-DroghiM, et al.Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study. Crit Care. 2016;20(1):142.
AtmowihardjoLNHeijnenNFLSmitMR, et al.Biomarkers of alveolar epithelial injury and endothelial dysfunction are associated with scores of pulmonary edema in invasively ventilated patients. Am J Physiol Lung Cell Mol Physiol. 2023;324(1):L38–L47.
28.
HeHHuQLongY, et al.Effects of high PEEP and fluid administration on systemic circulation, pulmonary microcirculation, and alveoli in a canine model. J Appl Physiol (1985). 2019;127(1):40–46.
29.
SchittnyJC. Development of the lung. Cell Tissue Res. 2017;367(3):427–444.
30.
GlennyRRobertsonHT. Distribution of perfusion. Compr Physiol. 2011;1(1):245–262.
31.
GlennyRWRobertsonHT. Spatial distribution of ventilation and perfusion: Mechanisms and regulation. Compr Physiol. 2011;1(1):375–395.
32.
GlennyRWRobertsonHT. Determinants of pulmonary blood flow distribution. Compr Physiol. 2011;1(1):39–59.
33.
TownsleyMI. Structure and composition of pulmonary arteries, capillaries, and veins. Compr Physiol. 2012;2(1):675–709.
34.
WestJB. Fragility of pulmonary capillaries. J Appl Physiol(1985)2013;115(1):1–15.
MatuszakJTabuchiAKueblerWM. Ventilation and perfusion at the alveolar level: Insights from lung intravital microscopy. Front Physiol. 2020;11:291.
37.
WeinbaumSTarbellJMDamianoER. The structure and function of the endothelial glycocalyx layer. Annu Rev Biomed Eng. 2007;9:121–167.
38.
SchmidtEPYangYJanssenWJ, et al.The pulmonary endothelial glycocalyx regulates neutrophil adhesion and lung injury during experimental sepsis. Nat Med. 2012;18(8):1217–1223.
39.
Burke-GaffneyAEvansTW. Lest we forget the endothelial glycocalyx in sepsis. Crit Care. 2012;16(2):121.
40.
SchmidtEPLiGLiL, et al.The circulating glycosaminoglycan signature of respiratory failure in critically ill adults. J Biol Chem. 2014;289(12):8194–8202.
41.
HopkinsSRSticklandMK. The pulmonary vasculature. Semin Respir Crit Care Med. 2023;44(5):538–554.
42.
HuiSCowanAJZengX, et al.Quantitative fluxomics of circulating metabolites. Cell Metab. 2020;32(4):676–688e674.
43.
KhaingPPanditPAwsareBSummerR. Pulmonary circulation in obesity, diabetes, and metabolic syndrome. Compr Physiol. 2019;10(1):297–316.
44.
ParkerJCYoshikawaS. Vascular segmental permeabilities at high peak inflation pressure in isolated rat lungs. Am J Physiol Lung Cell Mol Physiol. 2002;283(6):L1203–L1209.
45.
ArmstrongSMKhajoeeVWangC, et al.Co-regulation of transcellular and paracellular leak across microvascular endothelium by dynamin and Rac. Am J Pathol. 2012;180(3):1308–1323.
46.
MehtaDRavindranKKueblerWM. Novel regulators of endothelial barrier function. Am J Physiol Lung Cell Mol Physiol. 2014;307(12):L924–L935.
47.
SimmonsSErfinandaLBartzCKueblerWM. Novel mechanisms regulating endothelial barrier function in the pulmonary microcirculation. J Physiol. 2019;597(4):997–1021.
48.
SchuppJCAdamsTSCosmeCJr., ,Pet al. Integrated single-cell atlas of endothelial cells of the human lung. Circulation2021;144(4):286–302.
49.
SlingoME. Oxygen-sensing pathways and the pulmonary circulation. J Physiol. 2024;602(21):5619–5629.
YuBWangXSongY, et al.The role of hypoxia-inducible factors in cardiovascular diseases. Pharmacol Ther. 2022;238:108186.
52.
WangLYinJNicklesHT, et al.Hypoxic pulmonary vasoconstriction requires connexin 40-mediated endothelial signal conduction. J Clin Invest. 2012;122(11):4218–4230.
53.
ZhouHSLiMSuiBD, et al.Lipopolysaccharide impairs permeability of pulmonary microvascular endothelial cells via Connexin40. Microvasc Res. 2018;115:58–67.
54.
AirdWC. Phenotypic heterogeneity of the endothelium: I. Structure, function, and mechanisms. Circ Res. 2007;100(2):158–173.
55.
EppihimerMJWolitzkyBAndersonDCLabowMAGrangerDN. Heterogeneity of expression of E- and P-selectins in vivo. Circ Res. 1996;79(3):560–569.
56.
HoMHickeyMJMurrayAGAndoneguiGKubesP. Visualization of plasmodium falciparum-endothelium interactions in human microvasculature: Mimicry of leukocyte recruitment. J Exp Med. 2000;192(8):1205–1211.
57.
De BackerDDonadelloKSakrY, et al.Microcirculatory alterations in patients with severe sepsis: Impact of time of assessment and relationship with outcome. Crit Care Med. 2013;41(3):791–799.
58.
MisangoDPattnaikRBakerTDunserMWDondorpAMSchultzMJ, Global Intensive Care Working G, of the European Society of Intensive Care M, the Mahidol Oxford Tropical Medicine Research Unit in Bangkok T. Haemodynamic assessment and support in sepsis and septic shock in resource-limited settings. Trans R Soc Trop Med Hyg2017;111(11):483–489.
59.
HernandezGOspina-TasconGADamianiLP, et al.Effect of a resuscitation strategy targeting peripheral perfusion Status vs Serum lactate levels on 28-day mortality among patients with septic shock: The ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321(7):654–664.
60.
SoarJBergKMAndersenLW, et al.Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2020;156:A80–A119.
61.
RhodesAEvansLEAlhazzaniW, et al.Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552.
62.
MaheshwariKNathansonBHMunsonSH, et al.The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med. 2018;44(6):857–867.
63.
O'GaraPTKushnerFGAscheimDD, ,A et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines. Circulation2013;127(4):e362–e425.
64.
AmelootKJakkulaPHastbackaJ, et al.Optimum blood pressure in patients with shock after acute myocardial infarction and cardiac arrest. J Am Coll Cardiol. 2020;76(7):812–824.
65.
ThooftAFavoryRSalgadoDR, et al.Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care. 2011;15(5):R222.
66.
Vieillard-BaronACailleVCharronCBelliardGPageBJardinF. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008;36(6):1701–1706.
67.
O'GaraPTKushnerFGAscheimDD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol2013;61(4):485–510.
68.
BursteinBTabiMBarsnessGWBellMRKashaniKJentzerJC. Association between mean arterial pressure during the first 24 h and hospital mortality in patients with cardiogenic shock. Crit Care. 2020;24(1):513.
69.
ParlowSDi SantoPMathewR, et al. The association between mean arterial pressure and outcomes in patients with cardiogenic shock: Insights from the DOREMI trial. Eur Heart J Acute Cardiovasc Care2021;10(7):712–720.
70.
BourgoinALeoneMDelmasAGarnierFAlbaneseJMartinC. Increasing mean arterial pressure in patients with septic shock: Effects on oxygen variables and renal function. Crit Care Med. 2005;33(4):780–786.
71.
LeDouxDAstizMECarpatiCMRackowEC. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000;28(8):2729–2732.
72.
DubinAPozoMOCasabellaCA, et al.Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: A prospective study. Crit Care2009;13(3):R92.
73.
LemasleLBletAGevenC, et al.Bioactive adrenomedullin, organ support therapies, and survival in the critically ill: Results from the French and European outcome registry in ICU study. Crit Care Med. 2020;48(1):49–55.
74.
LamontagneFMarshallJCAdhikariNKJ. Permissive hypotension during shock resuscitation: Equipoise in all patients?Intensive Care Med. 2018;44(1):87–90.
75.
AsfarPMezianiFHamelJF, et al.High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370(17):1583–1593.
76.
LamontagneFCookDJMeadeMO, et al.Vasopressor use for severe hypotension-A multicentre prospective observational study. PLoS One. 2017;12(1):e0167840.
77.
RhodesAEvansLEAlhazzaniW, et al.Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304–377.
78.
AnnaneDOuanes-BesbesLde BackerD, et al.A global perspective on vasoactive agents in shock. Intensive Care Med. 2018;44(6):833–846.
79.
TacconeFSSuFHeX, et al.Effects of Reversal of Hypotension on Cerebral Microcirculation and Metabolism in Experimental Sepsis. Biomedicines. 2022;10(4):923.
80.
ByrneLObonyoNGDiabSD, et al.Unintended consequences: Fluid resuscitation worsens shock in an ovine model of endotoxemia. Am J Respir Crit Care Med. 2018;198(8):1043–1054.
81.
Dopp-ZemelDGroeneveldAB. High-dose norepinephrine treatment: Determinants of mortality and futility in critically ill patients. Am J Crit Care. 2013;22(1):22–32.
82.
MartinCMedamSAntoniniF, et al.Norepinephrine: Not too much, too long. Shock. 2015;44(4):305–309.
83.
KindermansMJoachimJManquatE, et al.Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: A prospective preliminary study. BMC Anesthesiol. 2023;23(1):374.
84.
HollenbergSM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011;183(7):847–855.
85.
PotermanMVosJJVereeckeHE, et al.Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: A randomised controlled trial. Eur J Anaesthesiol. 2015;32(8):571–580.
86.
LumbABSlingerP. Hypoxic pulmonary vasoconstriction: Physiology and anesthetic implications. Anesthesiology. 2015;122(4):932–946.
87.
ZangrilloALandoniGBerettaL, et al.Angiotensin II infusion in COVID-19-associated vasodilatory shock: A case series. Crit Care. 2020;24(1):227.
88.
WieruszewskiPMColemanPJLevineAR, et al.Trajectory of PaO(2)/FiO(2) ratio in shock after angiotensin II. J Intensive Care Med. 2023;38(10):939–948.
89.
LeismanDEHandisidesDRChawlaLS, et al.Angiotensin II treatment is associated with improved oxygenation in ARDS patients with refractory vasodilatory shock. Ann Intensive Care. 2023;13(1):128.
90.
LawlerPRDerdeLPGMcVerryBJRussellJAvan de VeerdonkFL. The renin-angiotensin system in acute lung injury. Crit Care Med. 2022;50(9):1411–1415.
91.
Writing Committee for the R-CAPI, LawlerPRDerdeLPGvan de VeerdonkFL, et al. Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19: A randomized clinical trial. JAMA2023;329(14):1183–1196.
92.
LipworthBJDaggKD. Vasoconstrictor effects of angiotensin II on the pulmonary vascular bed. Chest. 1994;105(5):1360–1364.
93.
CargillRILipworthBJ. Acute effects of hypoxaemia and angiotensin II in the human pulmonary vascular bed. Pulm Pharmacol. 1994;7(5):305–310.
94.
PatelBMChittockDRRussellJAWalleyKR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology. 2002;96(3):576–582.
95.
KhannaAEnglishSWWangXS, et al.Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377(5):419–430.
96.
RussellJAWalleyKRSingerJ, et al.Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877–887.
97.
GordonACMasonAJThirunavukkarasuN, et al.Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock: The VANISH randomized clinical trial. JAMA. 2016;316(5):509–518.
98.
McIntyreWFUmKJAlhazzaniW, et al.Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: A systematic review and meta-analysis. JAMA. 2018;319(18):1889–1900.
99.
LiuZMChenJKouQ, et al.Terlipressin versus norepinephrine as infusion in patients with septic shock: A multicentre, randomised, double-blinded trial. Intensive Care Med. 2018;44(11):1816–1825.
100.
De BackerDFoulonP. Minimizing catecholamines and optimizing perfusion. Crit Care. 2019;23(Suppl 1):149.
101.
ParkinWGLeaningMS. Therapeutic control of the circulation. J Clin Monit Comput. 2008;22(6):391–400.
102.
VellingaNAInceCBoermaEC. Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: A hypothesis generating post hoc analysis. BMC Anesthesiol. 2013;13:17.
103.
WangXTYaoBLiuDWZhangHM. Central venous pressure dropped early is associated with organ function and prognosis in septic shock patients: A retrospective observational study. Shock. 2015;44(5):426–430.
104.
GuinotPGAbou-ArabOLongroisDDupontH. Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: An observational study. Eur J Anaesthesiol. 2015;32(8):535–542.
105.
XiaoWLiuWZhangJ, et al.Early persistent exposure to high CVP is associated with increased mortality and AKI in septic shock: A retrospective study. Am J Emerg Med. 2023;74:146–151.
106.
ZhangLZhangZGChoppM. The neurovascular unit and combination treatment strategies for stroke. Trends Pharmacol Sci. 2012;33(8):415–422.
107.
BudohoskiKPGuilfoyleMHelmyA, et al.The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2014;85(12):1343–1353.
108.
OhkumaHManabeHTanakaMSuzukiS. Impact of cerebral microcirculatory changes on cerebral blood flow during cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2000;31(7):1621–1627.
109.
De SilvaDAFinkJNChristensenS, et al.Assessing reperfusion and recanalization as markers of clinical outcomes after intravenous thrombolysis in the echoplanar imaging thrombolytic evaluation trial (EPITHET). Stroke. 2009;40(8):2872–2874.
110.
NgFCChurilovLYassiN, et al.Prevalence and significance of impaired microvascular tissue reperfusion despite macrovascular angiographic reperfusion (No-reflow). Neurology. 2022;98(8):e790–e801.
111.
van LeeuwenALIDekkerNAMVan SlykeP, et al.The effect of targeting Tie2 on hemorrhagic shock-induced renal perfusion disturbances in rats. Intensive Care Med Exp. 2021;9(1):23.
112.
GuerciPErginBKapucuA, et al.Effect of polyethylene-glycolated carboxyhemoglobin on renal microcirculation in a rat model of hemorrhagic shock. Anesthesiology. 2019;131(5):1110–1124.
113.
StarrMCBanksRReederRW, et al.Severe acute kidney injury is associated with increased risk of death and new morbidity after pediatric septic shock. Pediatr Crit Care Med. 2020;21(9):e686–e695.
114.
MarshallJC. The liver in sepsis: Shedding light on the cellular basis of hepatocyte dysfunction. Crit Care. 2013;17(3):153.
115.
De BackerDCreteurJDuboisMJSakrYVincentJL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147(1):91–99.
116.
WuYRenJZhouB, et al.Laser speckle contrast imaging for measurement of hepatic microcirculation during the sepsis: A novel tool for early detection of microcirculation dysfunction. Microvasc Res. 2015;97:137–146.
117.
SchulzJKramerSKanatliY, et al.Sodium thiosulfate improves intestinal and hepatic microcirculation without affecting mitochondrial function in experimental sepsis. Front Immunol. 2021;12:671935.
118.
ZhengLKellyCJColganSP. Physiologic hypoxia and oxygen homeostasis in the healthy intestine. A review in the theme: Cellular responses to hypoxia. Am J Physiol Cell Physiol. 2015;309(6):C350–C360.
119.
HaussnerFChakrabortySHalbgebauerRHuber-LangM. Challenge to the intestinal Mucosa during sepsis. Front Immunol. 2019;10:891.
120.
TangALShenMJZhangGQ. Intestinal microcirculation dysfunction in sepsis: Pathophysiology, clinical monitoring, and therapeutic interventions. World J Emerg Med. 2022;13(5):343–348.
121.
MuccioliGGNaslainDBackhedF, et al.The endocannabinoid system links gut microbiota to adipogenesis. Mol Syst Biol. 2010;6:392.
122.
KuebartAGrossKRipkensJJ, et al.Pravastatin Improves Colonic and Hepatic Microcirculatory Oxygenation during Sepsis without Affecting Mitochondrial Function and ROS Production in Rats. Int J Mol Sci. 2023;24(6):5455.
123.
TeliasIBrochardLGoligherEC. Is my patient's respiratory drive (too) high?Intensive Care Med. 2018;44(11):1936–1939.
124.
HeunksLOttenheijmC. Diaphragm-Protective mechanical ventilation to improve outcomes in ICU patients?Am J Respir Crit Care Med. 2018;197(2):150–152.
125.
CarteauxGCordoba-IzquierdoALyazidiAHeunksLThilleAWBrochardL. Comparison between neurally adjusted ventilatory assist and pressure support ventilation levels in terms of respiratory effort. Crit Care Med. 2016;44(3):503–511.
126.
VaporidiKAkoumianakiETeliasIGoligherECBrochardLGeorgopoulosD. Respiratory drive in critically ill patients. Pathophysiology and clinical implications. Am J Respir Crit Care Med. 2020;201(1):20–32.
127.
Del NegroCAFunkGDFeldmanJL. Breathing matters. Nat Rev Neurosci. 2018;19(6):351–367.
128.
CostaRNavalesiPCammarotaG, et al.Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist. Respir Physiol Neurobiol. 2017;244:10–16.
129.
VaschettoRCammarotaGColomboD, et al.Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med. 2014;42(1):74–82.
130.
DresMGoligherECHeunksLMABrochardLJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017;43(10):1441–1452.
131.
KaragiannidisCHesselmannFFanE. Physiological and technical considerations of extracorporeal CO(2) removal. Crit Care. 2019;23(1):75.
132.
GalvinIDrummondGBNirmalanM. Distribution of blood flow and ventilation in the lung: Gravity is not the only factor. Br J Anaesth. 2007;98(4):420–428.
133.
GuerinCReignierJRichardJC, et al.Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–2168.
134.
Rayner-HartleyEMillerPEBursteinB, et al.The basics of ARDS mechanical ventilatory care for cardiovascular specialists. Can J Cardiol. 2020;36(10):1675–1679.
135.
DupontHDepuydtPAbrougF. Prone position acute respiratory distress syndrome patients: Less prone to ventilator associated pneumonia?Intensive Care Med. 2016;42(5):937–939.
136.
LiaoXMengLZengZ. Prone position ventilation for the relief of acute respiratory distress syndrome through improved pulmonary ventilation: Efficacy and safety. Nurs Crit Care. 2024;29(2):255–273.
137.
WieslanderBRamosJGAxMPeterssonJUganderM. Supine, prone, right and left gravitational effects on human pulmonary circulation. J Cardiovasc Magn Reson. 2019;21(1):69.
138.
ArinaPSingerM. Pathophysiology of sepsis. Curr Opin Anaesthesiol. 2021;34(2):77–84.
139.
HuangWLiuDZhangHDingXWangX, Critical Care Ultrasound Study G. Focus on host/organ unregulated response: A common cause of critical illness. Chin Med J (Engl)2023;136(1):108–110.
140.
SingerMDeutschmanCSSeymourCW, et al.The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–810.
141.
OsuchowskiMFWinklerMSSkireckiT, et al.The COVID-19 puzzle: Deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respir Med. 2021;9(6):622–642.
142.
DunserMWHasibederWR. Sympathetic overstimulation during critical illness: Adverse effects of adrenergic stress. J Intensive Care Med. 2009;24(5):293–316.
143.
MorelliADonatiAErtmerC, et al.Microvascular effects of heart rate control with esmolol in patients with septic shock: A pilot study. Crit Care Med. 2013;41(9):2162–2168.
144.
CarraraMFerrarioMBollen PintoBHerpainA. The autonomic nervous system in septic shock and its role as a future therapeutic target: A narrative review. Ann Intensive Care. 2021;11(1):80.
145.
MorelliAErtmerCWestphalM, et al.Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: A randomized clinical trial. JAMA. 2013;310(16):1683–1691.
146.
GeloenAChapelierKCividjianA, et al.Clonidine and dexmedetomidine increase the pressor response to norepinephrine in experimental sepsis: A pilot study. Crit Care Med. 2013;41(12):e431–e438.
147.
WangGZhangHLiuDWangX, Chinese Critical Ultrasound Study G. Resuscitation fluids as drugs: Targeting the endothelial glycocalyx. Chin Med J (Engl)2022;135(2):137–144.
148.
NaumannDNHazeldineJBishopJ, et al.Impact of plasma viscosity on microcirculatory flow after traumatic haemorrhagic shock: A prospective observational study. Clin Hemorheol Microcirc. 2019;71(1):71–82.
149.
Torres FilhoIPSpiessBDPittmanRNBarbeeRWWardKR. Experimental analysis of critical oxygen delivery. Am J Physiol Heart Circ Physiol. 2005;288(3):H1071–H1079.
150.
GeYLLvRZhouWMaXXZhongTDDuanML. Brain damage following severe acute normovolemic hemodilution in combination with controlled hypotension in rats. Acta Anaesthesiol Scand. 2007;51(10):1331–1337.
151.
MontomoliJDonatiAInceC. Acute kidney injury and fluid resuscitation in septic patients: Are we protecting the kidney?Nephron. 2019;143(3):170–173.
152.
ShepherdAPRiedelGL. Optimal hematocrit for oxygenation of canine intestine. Circ Res. 1982;51(2):233–240.
153.
van BommelJSiegemundMHennyCPTrouwborstAInceC. Critical hematocrit in intestinal tissue oxygenation during severe normovolemic hemodilution. Anesthesiology. 2001;94(1):152–160.
154.
VillelaNRSalazar VazquezBYIntagliettaM. Microcirculatory effects of intravenous fluids in critical illness: Plasma expansion beyond crystalloids and colloids. Curr Opin Anaesthesiol. 2009;22(2):163–167.
155.
ItoTKakuuchiMMaruyamaI. Endotheliopathy in septic conditions: Mechanistic insight into intravascular coagulation. Crit Care. 2021;25(1):95.
156.
MorariuAMMaathuisMHAsgeirsdottirSA, et al.Acute isovolemic hemodilution triggers proinflammatory and procoagulatory endothelial activation in vital organs: Role of erythrocyte aggregation. Microcirculation. 2006;13(5):397–409.
157.
CaltabelotiFMonselAArbelotC, et al.Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: A lung ultrasound observational study. Crit Care. 2014;18(3):R91.
158.
MessmerASZinggCMullerMGerberJLSchefoldJCPfortmuellerCA. Fluid overload and mortality in adult critical care patients-A systematic review and meta-analysis of observational studies. Crit Care Med. 2020;48(12):1862–1870.
159.
LimaAvan RooijTErginB, et al.Dynamic contrast-enhanced ultrasound identifies microcirculatory alterations in sepsis-induced acute kidney injury. Crit Care Med. 2018;46(8):1284–1292.
160.
ChenRGaoBWangXZhaoHWangXLiuD. Ultrasonographic assessment of renal microcirculation is a new vision for the treatment of intensive care unit associated acute kidney injury. Eur J Med Res. 2024;29(1):115.
161.
RhodesAEvansLEAlhazzaniW, et al.Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552.
162.
TorresLNChungKKSalgadoCLDubickMATorres FilhoIP. Low-volume resuscitation with normal saline is associated with microvascular endothelial dysfunction after hemorrhage in rats, compared to colloids and balanced crystalloids. Crit Care. 2017;21(1):160.
163.
ZampieriFGHjortrupPB. Moving albumin into the small volume resuscitation era. Intens Care Med. 2018;44(11):1967–1969.
164.
MartinGSBassettP. Crystalloids vs. Colloids for fluid resuscitation in the intensive care unit: A systematic review and meta-analysis. J Crit Care. 2019;50:144–154.
165.
StraatMMuellerMCAMeijersJCM, et al.Effect of transfusion of fresh frozen plasma on parameters of endothelial condition and inflammatory status in non-bleeding critically ill patients: a prospective substudy of a randomized trial. Crit Care.2015;19(1):163.
