What is the utility of blood "microcirculation" diagnosis and monitoring?

[Dr Alain L Fymat]

Blood microcirculation is the smallest functional unit of the cardiovascular system and the site of interaction between blood and tissue. It is clinically evaluated primarily on the basis of physical examination. However, current clinical focus on the macrocirculation (including cardiac output, large vessel pressures and flows, etc.) provides very limited insight into the mechanisms operating at the exchange sites (especially the capillaries).

The clinical implications are pertinent to the understanding of "distributive shock" or failure of the blood circulation even though the macrocirculation (specifically cardiac output and arterial pressure) is maintained at or near normal levels. In such clinical settings, there is evidence that the microcirculation is responsible for impaired tissue oxygenation and delivery of vital substrates in addition to oxygen, together with failure to eliminate products of metabolism including carbon dioxide and lactic acid (see, e.g., Weil and Tang, 2007).

I (and others) can see the following utilities in the diagnosis and monitoring of the microcirculation:

(1) In the assessment of circulatory failure in patients in the ICU/ER, it can provide a triage tool, an indicator of shock and sepsis in early goal-directed therapy, a sounding alarm of impending shock in cardiac surgery, and for monitoring shock therapy;
(2) In the assessment of heart function, it can provide a CPR resuscitation tool, identify conditions of low cardiac output, optimize cardiac assist devices, and monitor perfusion during cardiac surgery; and
(3) In the assessment of tissue perfusion, it can serve to monitor wound healing, transplant surgery, plastic surgery, diabetes, and brain pressure/perfusion.

CAN YOU THINK OF OTHER UTILITIES? I INVITE YOUR THOUGHTS AND COMMENTS.