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Postgraduate Education Corner: Contemporary Reviews in Critical Care Medicine |

Monitoring Tissue Perfusion, Oxygenation, and Metabolism in Critically Ill PatientsMonitoring Tissue Perfusion in the Critically Ill

Nasirul J. Ekbal, MBBS; Alex Dyson, PhD; Claire Black, MSc; Mervyn Singer, MD
Author and Funding Information

From the Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, England.

Correspondence to: Prof Mervyn Singer, MD, Bloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Bldg, Gower St, London, WC1E 6BT, England; e-mail: m.singer@ucl.ac.uk


Funding/Support: The authors work at University College London Hospitals/University College London, which receives a proportion of its funding from the UK Department of Health’s National Institute for Health Research Biomedical Research Centre’s funding scheme. Dr Ekbal is funded by the Medical Research Council and Claire Black by the UK National Institute for Health Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1799-1808. doi:10.1378/chest.12-1849
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Alterations in oxygen transport and use are integral to the development of multiple organ failure; therefore, the ultimate goal of resuscitation is to restore effective tissue oxygenation and cellular metabolism. Hemodynamic monitoring is the cornerstone of management to promptly identify and appropriately manage (impending) organ dysfunction. Prospective randomized trials have confirmed outcome benefit when preemptive or early treatment is directed toward maintaining or restoring adequate tissue perfusion. However, treatment end points remain controversial, in large part because of current difficulties in determining what constitutes “optimal.” Information gained from global whole-body monitoring may not detect regional organ perfusion abnormalities until they are well advanced. Conversely, the ideal “canary” organ that is readily accessible for monitoring, yet offers an early and sensitive indicator of tissue “unwellness,” remains to be firmly identified. This review describes techniques available for real-time monitoring of tissue perfusion and metabolism and highlights novel developments that may complement or even supersede current tools.

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