Advancing Microcirculatory Therapies in Pediatric Sepsis: Current Opportunities and Future Directions.

Microcirculatory dysfunction in pediatric sepsis is a key factor in the development of tissue hypoperfusion and multiple organ failure. Endothelial glycocalyx alteration, increased capillary permeability, and blood flow heterogeneity are common findings in these patients, suggesting that a microcirculation-targeted approach could improve clinical outcomes. In this context, strategies such as resuscitation with balanced solutions have been shown to minimize hyperchloremia and metabolic acidosis, reducing endothelial dysfunction and inflammatory activation. Likewise, correcting hypoalbuminemia has been associated with reduced glycocalyx degradation and improved vascular stability. The use of inotropes and inodilators has shown favorable effects on capillary perfusion and modulation of the inflammatory response, suggesting their potential to optimize tissue oxygenation in septic shock patients. Additionally, fresh frozen plasma may play a role in glycocalyx restoration and endothelial homeostasis regulation, although its impact on pediatric sepsis still requires further clinical evidence. Despite these advances, questions remain regarding the best strategy to evaluate and treat microcirculatory dysfunction in children with sepsis. Identifying specific biomarkers and developing tools for real-time perfusion assessment could allow for more personalized therapies. Further clinical studies are needed to validate the impact of these interventions on pediatric mortality and morbidity. Integrating a microcirculation-targeted approach into pediatric septic shock management protocols represents an opportunity to improve care and outcomes in this vulnerable population.