Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation

The resuscitation of the patient in shock is a highly complex endeavor which should go beyond normalizing mean arterial pressure and protocolized fluid loading. We propose a holistic, four interface conceptual model of shock which we feel can benefit both clinicians at the bedside and researchers. The four circulatory interfaces whose uncoupling result in shock are the left ventricle to arterial, the arterial to capillary, the capillary to venular and finally the right ventricle to pulmonary artery. We review the pathophysiology and clinical consequences behind the uncoupling of these interfaces as well as how to assess them and propose a strategy on how to approach the patient in shock. Bedside assessment of shock may include these critical interfaces in order to avoid hemodynamic incoherence and focus on microcirculatory restoration rather than simply mean arterial pressure. Further research may incorporate these concepts.