Integrating Macro- and Microcirculatory Monitoring in Pediatric Critical Care: Advances in Bedside Ultrasound, Capillaroscopy, and Precision Hemodynamic Assessment

Accurate assessment of hemodynamics and tissue perfusion remains a cornerstone of pediatric critical care. Despite advances in point-of-care ultrasound (POCUS)–based protocols such as focused echocardiography and venous congestion assessment (e.g., VExUS), conventional approaches primarily reflect macrovascular physiology and may fail to detect microcirculatory dysfunction due to loss of hemodynamic coherence.In parallel, emerging bedside technologies such as nailfold videocapillaroscopy (NVC) enable real-time visualization of microvascular alterations, including endothelial dysfunction and interstitial fluid shifts. Parameters such as perivascular zone (PZ) dynamics offer a novel, non-invasive approach to quantify peripheral edema and microcirculatory impairment. Integrating macro- and microcirculatory monitoring therefore provides a more comprehensive, multidimensional framework for evaluating fluid responsiveness, guiding vasoactive therapy, and optimizing resuscitation strategies in critically ill children.This Research Topic aims to bring together clinicians, researchers, and biomedical scientists to explore the integration of macro- and microhemodynamic assessment tools in pediatric and neonatal critical care. It seeks to bridge the gap between systemic hemodynamic evaluation and tissue-level perfusion monitoring, with a focus on improving diagnostic precision and therapeutic decision-making at the bedside.The scope of this Research Topic includes, but is not limited to:• Integration of POCUS modalities (focused cardiac ultrasound, IVC assessment, abdominal Doppler, and VExUS) with microcirculatory monitoring techniques• Clinical applications of nailfold videocapillaroscopy (NVC) in pediatric shock, sepsis, MIS-C, and inflammatory conditions• Non-invasive assessment of interstitial fluid accumulation and peripheral edema using perivascular zone (PZ) analysis• Evaluation of hemodynamic coherence and discordance between macro- and microcirculatory parameters• Correlation of macrohemodynamic indices (e.g., VExUS grading, carotid VTI, Doppler-based measures) with microcirculatory perfusion metrics• Role of combined monitoring strategies in guiding fluid resuscitation, vasoactive therapy, and de-resuscitation• Applications in sepsis, septic shock, post-cardiac surgery, ECMO, and other pediatric critical illness states• Advances in precision hemodynamic monitoring, including AI-assisted and data-driven decision support tools• Translational and methodological studies linking endothelial function, microcirculation, and bedside imaging technologies.By integrating macrovascular and microvascular perspectives, this Research Topic aims to advance precision hemodynamic monitoring in pediatric critical care and improve individualized management strategies for critically ill children. Ultimately, it seeks to redefine bedside assessment by promoting a unified, physiology-driven approach to circulatory monitoring. Topic editors: Jai Udassi, Gul Sher, Michael Lintner-Rivera Source: https://www.frontiersin.org/research-topics/83868/integrating-macro--and-microcirculatory-monitoring-in-pediatric-critical-care-advances-in-bedside-ultrasound-capillaroscopy-and-precision-hemodynamic-assessment