SCCM Podcast

SCCMPod-561: Microcirculation and Shock in Critical Care

Dec 18, 2025
Olfa Hamzaoui, a professor of intensive care at Robert Debré Hospital and a leading researcher in cardiovascular monitoring, discusses her insights on microcirculation and shock. She highlights the importance of capillary refill time as a simple tool for guiding resuscitation and advocates for early echocardiographic assessments in shock management. Hamzaoui also explores the limitations of handheld video microscopy and the significance of titrating norepinephrine to individualized targets, bridging the gap between cutting-edge research and practical bedside applications.
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INSIGHT

Microcirculation Disturbances Are Early And Complex

  • Microcirculatory disturbances occur early in shock and link to outcomes in sepsis and cardiogenic shock.
  • Current bedside micro tools (HVMS) are limited by artifacts, cost, and offline analysis so routine use is premature.
INSIGHT

Handheld Video Microscopy Is Not Yet Practical

  • Handheld video microscopy (HVMS) drove most microcirculation research but remains impractical for routine bedside use.
  • Automation, artifact reduction, and faster analysis are needed before clinical adoption.
ADVICE

Titrate Norepinephrine Using STO2 Recovery Slope

  • Measure STO2 recovery slope with a vaso-occlusive test to detect microvascular response to norepinephrine.
  • Use individual change in recovery slope to decide whether increasing MAP with norepinephrine benefits that patient.
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