Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion

Q: What are the key findings of this study?

Circulatory shock is a state of acute circulatory failure requiring management based on pathophysiological alterations rather than protocols, utilizing clinical indices like blood lactate and tissue perfusion.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Circulatory shock.

Q: What does this research mean for the field?

Effective management of circulatory shock requires assessing tissue hypoperfusion through clinical 'windows' such as the skin, kidneys, and brain, rather than relying solely on blood pressure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jooyun Kim; Saeyeon Kim; 이지희; Sua Kim

doi:10.4266/acc.003425

May 28, 2026Acute and Critical CareOpen Access

Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion

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Key result

Pathophysiology-guided management of circulatory shock using clinical indices is recommended over rigid protocols.

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Why the study?

Circulatory shock is common and carries high morbidity and mortality, and appropriate treatment depends on understanding the underlying pathophysiological mechanisms.

Key Points

To review the pathophysiological mechanisms, classification, and clinical monitoring of circulatory shock, emphasizing indices of tissue hypoperfusion beyond conventional blood pressure measurements.
Synthesized historical and modern physiological frameworks classifying acute circulatory failure into hypovolemic, cardiogenic, obstructive, and distributive mechanisms.
Evaluated systemic clinical indices, laboratory biomarkers (blood lactate concentrations), and microvascular monitoring modalities across organ-specific beds.
Systolic arterial pressure <90 mmHg is an arbitrary threshold that can be masked by compensatory vasoconstriction, whereas blood lactate concentrations >2 mEq/L (and even 1.5 to 2.0 mEq/L) indicate shock and increased mortality.
Altered tissue perfusion is clinically manifested through three accessible organ windows: the skin (cold, clammy skin, slowed capillary refill), the kidneys (oliguria <0.5 mL/kg/h), and the brain (obtundation, disorientation, or confusion).
Microvascular alterations—including endothelial dysfunction, glycocalyx shedding, and microcirculatory shunting—occur across all shock states and produce heterogeneous tissue hypoxia.

PICO

P

Population

Circulatory shock

Provides an updated overview of the description, classification, and management of shock states and tissue hypoperfusion.

Limitations

Current technology for monitoring the microcirculation is not yet ready for routine clinical use and requires further clinical trials.

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Implication

Supports clinician recognition of hypoperfusion; leaves open the need for prospective validation of updated indices.

Abstract

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Cite This Study

Kim et al. (2026) conducted a review in Circulatory shock. Circulatory shock is a state of acute circulatory failure requiring management based on pathophysiological alterations rather than protocols, utilizing clinical indices like blood lactate and tissue perfusion.

synapsesocial.com/papers/6a1bcf835783ba022b6fb934 https://doi.org/10.4266/acc.003425

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Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion

Figures

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion

Figures

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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