Quiero agradecer al Dr. Eduardo Kattan y a sus coautores (Rola, Miller, Haycock, Spiegel, Rikhraj, Hernández) por su reciente publicación en J Clin Med, "Understanding the Nuanced Concept of Hemodynamic Incoherence and Its Underlying Physiology".
El paper propone una distinción clínicamente muy útil entre incoherencia hemodinámica Tipo 1 (falla microcirculatoria primaria) y Tipo 2 (secundaria a constricción excesiva, bajo flujo o congestión venosa), mapeada sobre un modelo de 4 interfaces circulatorias. Un marco de razonamiento bedside que ayuda a decidir, frente a un paciente hipoperfundido con PAM "normal", si el problema está en el corazón, la arteriola, la microcirculación o el drenaje venoso — antes de seguir escalando vasopresores a ciegas.
Gracias por seguir empujando la fisiología aplicada a la cabecera del paciente crítico.
#MedicinaIntensiva #Hemodinamia #FOAMcc
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