Key result
Hemodynamic incoherence in shock displays distinct phenotypes with diverse mechanisms, warranting targeted treatment validation.
Why the study?
Hemodynamic incoherence occurs when microcirculatory dysfunction persists despite restoration of macrocirculatory function after shock resuscitation, and its mechanisms and phenotypes require better understanding.
This review provides a conceptual framework for understanding and classifying hemodynamic incoherence in shock patients, emphasizing the need to develop and validate targeted treatments based on specific microcirculatory phenotypes.
The reversal of microcirculation dysfunction is crucial for assessing the success of shock resuscitation and significantly influences patient prognosis. However, hemodynamic incoherence is observed when microcirculatory dysfunction persists despite the restoration of macrocirculatory function after resuscitation. Recent advancements in technology have enabled bedside assessment of microcirculation in shock patients, allowing for direct visualization of microcirculatory morphology and quantitative evaluation of its functional status. This article reviews the pathophysiological mechanisms that lead to hemodynamic incoherence. It also introduces the current understanding and classification framework for the different phenotypes of hemodynamic incoherence. Existing evidence indicates that the diverse mechanisms leading to microcirculatory disorders result in varied manifestations among patients experiencing hemodynamic incoherence, highlighting the heterogeneity of this population. Some classification frameworks have been proposed to enhance our understanding of these phenotypes. By integrating pathophysiological mechanisms, clinical symptoms, indicators of macrocirculation, microcirculation, tissue metabolism, and biomarkers, we can summarize certain clinical features of phenotypes in hemodynamic incoherence to form a conceptual framework. Additionally, strategies for creating targeted treatments based on different phenotypes require further validation.
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Huang et al. (2024) conducted a review in Hemodynamic incoherence in shock. Hemodynamic incoherence in shock patients presents with heterogeneous phenotypes driven by diverse pathophysiological mechanisms, requiring further validation for targeted treatments.
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