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Retinal blood flow in critical illness and systemic disease: a review
Courtie, E Logan, A Denniston, AK Blanch, RJ
Courtie, E
Logan, A
Denniston, AK
Blanch, RJ
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2020-11-12
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Abstract
Background: Assessment 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 body: Parallel 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. Conclusion: Monitoring 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.
Citation
Courtie, E, Veenith, T et al (2020) Retinal blood flow in critical illness and systemic disease: a review, Annals of Intensive Care, 10 (1), article 152
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Research Unit
PubMed ID
33184724 (pubmed)
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Journal article
Language
en
Description
© 2020 The Authors. Published by Springer. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s13613-020-00768-3
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ISSN
2110-5820
EISSN
2110-5820
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This project is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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Licence for published version: Creative Commons Attribution 4.0 International