Retinal blood flow in critical illness and systemic disease: a review

Annals of Intensive Care

A. Logan¹  T. Veenith²  A. K. Denniston³  E. Courtie⁴  R. J. Blanch⁵ 

[1] Axolotl Consulting Ltd, WR9 0JS, Droitwich, Worcestershire, UK;Division of Biomedical Sciences, Warwick Medical School, University of Warwick, CV4 7HL, Coventry, UK;Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK;Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK;Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK;Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK;

关键词: Critical illness;    Retinal blood flow;    Optical coherence tomography angiography;   

DOI  :  10.1186/s13613-020-00768-3

来源: Springer

【 摘 要 】

BackgroundAssessment and maintenance of end-organ perfusion are key to resuscitation in critical illness, although there are limited direct methods or proxy measures to assess cerebral perfusion. Novel non-invasive methods of monitoring microcirculation in critically ill patients offer the potential for real-time updates to improve patient outcomes.Main bodyParallel mechanisms autoregulate retinal and cerebral microcirculation to maintain blood flow to meet metabolic demands across a range of perfusion pressures. Cerebral blood flow (CBF) is reduced and autoregulation impaired in sepsis, but current methods to image CBF do not reproducibly assess the microcirculation. Peripheral microcirculatory blood flow may be imaged in sublingual and conjunctival mucosa and is impaired in sepsis. Retinal microcirculation can be directly imaged by optical coherence tomography angiography (OCTA) during perfusion-deficit states such as sepsis, and other systemic haemodynamic disturbances such as acute coronary syndrome, and systemic inflammatory conditions such as inflammatory bowel disease.ConclusionMonitoring microcirculatory flow offers the potential to enhance monitoring in the care of critically ill patients, and imaging retinal blood flow during critical illness offers a potential biomarker for cerebral microcirculatory perfusion.

【 授权许可】

CC BY