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

Abstract

Shock is a state of circulatory failure characterized by impaired tissue perfusion due to a mismatch between oxygen delivery and consumption. While macrocirculation serves as a conduit to sustain blood flow toward the microcirculatory networks, it is the microcirculation that ultimately ensures the delivery of oxygen and nutrients to maintain cellular and organ function. The maintenance of proper macrocirculation is essential, but it does not necessarily indicate adequate microcirculation or recovery from shock. Thus, assessment of the microcirculation is also required to confirm effective tissue oxygenation. A comprehensive evaluation of both circulatory levels is crucial for accurate diagnosis and prognostication in patients with shock. This review explores a diverse range of clinical, biochemical, and device-based indicators that reflect the perfusion status of patients in shock. By examining their physiological significance and clinical relevance, we aim to provide a comprehensive framework for the hemodynamic assessment of critically ill patients and support the use of multidimensional strategies in shock management.