Building on the success of Endothelial Activation and Microcirculatory Disorders in Sepsis and Critical Illness, we are pleased to relaunch Volume II of this Research Topic.Over the past two decades, clinical and experimental studies have shown that endothelial and microvascular dysfunction are the primary drivers of organ failure in multiple critical illnesses such as sepsis, cardiogenic shock, and trauma.From understanding the basic mechanisms of endothelial activation and signaling under inflammatory conditions to microcirculation monitoring and peripheral perfusion-guided resuscitation protocols; this field of research is one of the most dynamic and promising in the critical care community. Recently, the COVID-19 pandemic has increased the interest in endothelial dysfunction during severe infections or ARDS.The re-establishment and maintenance of tissue perfusion is a cornerstone of resuscitation protocols in critical illness and major surgery. Therefore, targeting endothelial activation or using strategies based on microcirculatory disorders might reduce organ failure. Although results from many preclinical studies and pilot clinical trials of endothelial-targeted treatments for sepsis have been encouraging, large controlled randomized trials have not yet convincingly shown that peripheral perfusion-guided resuscitation strategies improve sepsis outcomes.To date, a significant part of the clinical research on microcirculation is interested in integrating indices of perfusion and tissue oxygenation in the management of fluids and/or vasopressors in patients where apparent resuscitation macrohemodynamic targets have been met. Conversely, other approaches suggest limiting resuscitation fluids to protect the endothelium, or even using vasodilators.The multiple facets of the endothelial response under inflammatory conditions, characterized by an activation of coagulation and inhibition of fibrinolysis, hyperpermeability, redox imbalance, degradation of glycocalyx with rheological modification and intense production of inflammatory mediators partake in the complexity and heterogeneity of microcirculatory failure.Also, a better understanding of the underlying mechanisms supporting endothelial dysfunction, as well as improved identification and classification of microcirculatory-failure patient endotypes and endothelial targeted therapeutics are an exciting challenge for years to come.We welcome submissions of Original Research, Review, Mini Review, Case report, and correspondence focusing on the following aspects:• Basic endothelial biology focusing on the immune role of the endothelium, coagulation/fibrinolysis, oxidative stress, leukocytes/ platelets adhesion, rheology, vasoreactivity• Biomarker’s studies• Translational studies• Endothelial heterogeneity• Assessment and monitoring of the microcirculatory disorders in critical illness or major surgery.• Bioinformatic and digital solutions for real-time multiparametric hemodynamic. assessment and/or outcome prediction• Other intervention measures
Building on the success of Endothelial Activation and Microcirculatory Disorders in Sepsis and Critical Illness, we are pleased to relaunch Volume II of this Research Topic.Over the past two decades, clinical and experimental studies have shown that endothelial and microvascular dysfunction are the primary drivers of organ failure in multiple critical illnesses such as sepsis, cardiogenic shock, and trauma.From understanding the basic mechanisms of endothelial activation and signaling under inflammatory conditions to microcirculation monitoring and peripheral perfusion-guided resuscitation protocols; this field of research is one of the most dynamic and promising in the critical care community. Recently, the COVID-19 pandemic has increased the interest in endothelial dysfunction during severe infections or ARDS.The re-establishment and maintenance of tissue perfusion is a cornerstone of resuscitation protocols in critical illness and major surgery. Therefore, targeting endothelial activation or using strategies based on microcirculatory disorders might reduce organ failure. Although results from many preclinical studies and pilot clinical trials of endothelial-targeted treatments for sepsis have been encouraging, large controlled randomized trials have not yet convincingly shown that peripheral perfusion-guided resuscitation strategies improve sepsis outcomes.To date, a significant part of the clinical research on microcirculation is interested in integrating indices of perfusion and tissue oxygenation in the management of fluids and/or vasopressors in patients where apparent resuscitation macrohemodynamic targets have been met. Conversely, other approaches suggest limiting resuscitation fluids to protect the endothelium, or even using vasodilators.The multiple facets of the endothelial response under inflammatory conditions, characterized by an activation of coagulation and inhibition of fibrinolysis, hyperpermeability, redox imbalance, degradation of glycocalyx with rheological modification and intense production of inflammatory mediators partake in the complexity and heterogeneity of microcirculatory failure.Also, a better understanding of the underlying mechanisms supporting endothelial dysfunction, as well as improved identification and classification of microcirculatory-failure patient endotypes and endothelial targeted therapeutics are an exciting challenge for years to come.We welcome submissions of Original Research, Review, Mini Review, Case report, and correspondence focusing on the following aspects:• Basic endothelial biology focusing on the immune role of the endothelium, coagulation/fibrinolysis, oxidative stress, leukocytes/ platelets adhesion, rheology, vasoreactivity• Biomarker’s studies• Translational studies• Endothelial heterogeneity• Assessment and monitoring of the microcirculatory disorders in critical illness or major surgery.• Bioinformatic and digital solutions for real-time multiparametric hemodynamic. assessment and/or outcome prediction• Other intervention measures