hypoperfusion

Hypoperfusion is the inadequate delivery of blood flow to tissues, resulting in insufficient oxygen and nutrient supply at the cellular level. It can be systemic, as in shock, or regional, affecting a specific organ. It typically arises from reduced mean arterial pressure, low cardiac output, decreased circulating volume, or maladaptive distribution of blood flow.

Common causes include hypovolemia from blood loss or dehydration; cardiogenic failure such as myocardial infarction or decompensated heart failure; distributive shocks like sepsis or anaphylaxis; and obstructive states such as tamponade or pulmonary embolism. Mechanistically, reduced perfusion causes anaerobic metabolism, lactic acidosis, energy failure, and cell injury, with inflammation and capillary leak contributing to progressive organ dysfunction.

Clinically, hypoperfusion may present with hypotension, tachycardia, cool or mottled skin, and altered mental status, with decreased urine output and organ-specific signs. Labs often show elevated lactate and metabolic acidosis; creatinine may rise with kidney injury. Monitoring includes urine output, arterial blood gas, lactate, and, when available, imaging or Doppler measures of regional perfusion.

Management aims to restore perfusion and treat the cause. Fluids are used for volume depletion, with blood products for hemorrhage. Vasopressors such as norepinephrine maintain perfusion pressure; inotropes support cardiac output when needed. In distributive shock, addressing the underlying trigger is essential. Advanced therapies, including mechanical circulatory support, may be required in refractory cases, along with oxygen therapy and careful monitoring.