About this Research Topic
Evaluation of clinical conditions in sick children is usually first focused on respiratory and hemodynamic parameters such as respiratory rate, arterial O2 saturation, heart rate or blood pressure, and signs derived from clinical evaluation, such as main appearance, level of consciousness or capillary refill time. Although all these have already proven different utility to identify patients at higher risk of unfavorable evolution and capacity to be used as therapeutic guides, most of them are either inaccurate or unspecific indictors of organ functioning.
Adequate organ functioning relies on the ability of the body to provide its different organs with adequate oxygen and nutrient supplies to fulfill cellular needs. Misbalance between cellular requirements and substrates provided to the cells is defined as shock and causes organic dysfunction. Children have proven to be at higher risk of unnoticed or hidden shock.
Distribution of oxygen and nutrients from blood to cells and waste products from cells to blood takes place in the smallest blood vessels that constitute the microcirculatory compartment. Hemodynamic and respiratory functions are both determinants of an adequate oxygenation of the blood and distribution of the oxygenated blood to the different tissues, but functioning of the microcirculatory compartment is crucial in the intake of oxygen from the blood to the tissues and cells.
Techniques used to evaluate microcirculatory function are usually indirect and include biochemical markers in serum, measurement of tissue blood oxygen saturation using near infrared spectroscopy, quantification of tissue oxygen and carbon dioxide pressures, and measurement of different metabolites in tissues as pyruvate or lactate. Optical evaluation using different techniques as orthogonal polarization, sidestream darkfield imaging and lately Incidental Dark Field imaging provides direct visualization of microcirculation compartment at different sites. These are non-invasive techniques that evaluate anatomical structure of microcirculatory compartment and changes in microcirculatory blood flow. They are promising techniques that might be used in the clinical setting to guide treatment in children with different conditions to assure adequate tissue perfusion.
Developmental changes in microcirculatory compartment anatomy and functioning have already been proposed but specific descriptions on how microcirculation behaves during disease in children is still lacking of evidence in some aspects.
We propose to publish a collection of articles regarding microcirculatory evaluation in children. Articles should be focused not only on how microcirculation is affected, and changes in different disease conditions and treatments, but also in how microcirculation changes during growth in children.
Keywords: Microcirculation, Shock, Pediatric, Hemodinamic Monitoring, SDF imaging, IDF imaging
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