Shockingly complex: the difficult road to introducing new ideas to critical care

Resuscitation of critically ill patients with trauma or sepsis continues to challenge clinicians. Early imperatives include diagnostic judgment as to the presenting problem – sepsis or trauma. Subsequently, the clinician decides on the phase of resuscitation required for support – 'ebb' versus 'flow'. Finally, the clinician needs to determine what therapeutic strategies to employ and then judge when resuscitation is complete. Shortcomings of current approaches to determining the adequacy of circulatory resuscitation have prompted the evaluation of new technologies purported to directly assess microcirculatory flow as a clinical endpoint for the adequacy of resuscitation. While early studies are intriguing, this technology requires much more study before it can be considered for widespread adoption by the clinician.