• Jan Bakker.
• Columbia University Medical Center, Division of Pulmonary, Allergy, and Critical Care Medicine, 622 West 168th St, Room PH 8E-101, Office: PH 8-109, New York, NY 10032, USA; New York University, Department of Pulmonary and Critical Care, 462 First Avenue, New York, NY 10016, USA; Erasmus MC University Medical Center, Department of Intensive Care Adults, PO Box 2040-Room H-625, 3000 CA Rotterdam, Netherlands; Pontificia Universidad Católica de Chile, Department of Intensive Care, Diagonal Paraguay 362, 8330024 Santiago, Chile. Electronic address: jb3387@cumc.columbia.edu.
• Best Pract Res Clin Anaesthesiol. 2016 Dec 1; 30 (4): 523-530.

AbstractIn this review, the relationship between changes in macrohemodynamics during the development and treatment of acute circulatory failure is discussed in the context of coherence with microcirculation and changes in lactate. In models of circulatory failure, coherence between changes in macrocirculatory and microcirculatory perfusion and coherence with subsequent changes in lactate levels are more or less preserved. However, in patients, particularly those with septic shock, these relationships are much less clear. As many factors influence the effect of circulatory failure and infection on microcirculation and on lactate levels, this should not be surprising. Resuscitation should therefore aim at adequate tissue perfusion where systemic hemodynamics, microcirculatory perfusion parameters, and lactate levels should be used in their relevant context. This results in treating the individual patient as an n = 1 experiment.Copyright © 2016 Elsevier Ltd. All rights reserved.

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