Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock - PubMed (original) (raw)

Review

Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock

Daniel De Backer et al. Virulence. 2014.

Abstract

Multiple experimental and human trials have shown that microcirculatory alterations are frequent in sepsis. In this review, we discuss the various mechanisms that are potentially involved in their development and the implications of these alterations. Endothelial dysfunction, impaired inter-cell communication, altered glycocalyx, adhesion and rolling of white blood cells and platelets, and altered red blood cell deformability are the main mechanisms involved in the development of these alterations. Microcirculatory alterations increase the diffusion distance for oxygen and, due to the heterogeneity of microcirculatory perfusion in sepsis, may promote development of areas of tissue hypoxia in close vicinity to well-oxygenated zones. The severity of microvascular alterations is associated with organ dysfunction and mortality. At this stage, therapies to specifically target the microcirculation are still being investigated.

Keywords: endothelium; microcirculatory blood flow; organ failure; sepsis; tissue PCO2; tissue PO2; tonometry.

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Figure 1. Sublingual microcirculation in sepsis. Photograph of the sublingual microcirculation in a patient with septic shock using a sidestream dark field (SDF) imaging device. The white arrow shows a perfused capillary, the black arrows identify a stopped flow capillary.

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Figure 2. Relationship between sublingual microcirculation and ICU mortality in patients with severe sepsis. In this series of 252 patients with severe sepsis, the sublingual microcirculation was assessed either with an orthogonal polarization spectral (OPS) or a sidestream dark field (SDF) imaging device. The patients were grouped into quartiles of proportion of perfused capillaries. From reference with permission.

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