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Review
. 2004 Dec;8(6):462-8.
doi: 10.1186/cc2894. Epub 2004 Jun 16.

Bench-to-bedside review: sepsis is a disease of the microcirculation

Peter E Spronk  1 , Durk F Zandstra, Can Ince
Affiliations
Review

Bench-to-bedside review: sepsis is a disease of the microcirculation

Peter E Spronk et al. Crit Care. 2004 Dec.

Abstract

Microcirculatory perfusion is disturbed in sepsis. Recent research has shown that maintaining systemic blood pressure is associated with inadequate perfusion of the microcirculation in sepsis. Microcirculatory perfusion is regulated by an intricate interplay of many neuroendocrine and paracrine pathways, which makes blood flow though this microvascular network a heterogeneous process. Owing to an increased microcirculatory resistance, a maldistribution of blood flow occurs with a decreased systemic vascular resistance due to shunting phenomena. Therapy in shock is aimed at the optimization of cardiac function, arterial hemoglobin saturation and tissue perfusion. This will mean the correction of hypovolemia and the restoration of an evenly distributed microcirculatory flow and adequate oxygen transport. A practical clinical score for the definition of shock is proposed and a novel technique for bedside visualization of the capillary network is discussed, including its possible implications for the treatment of septic shock patients with vasodilators to open the microcirculation.

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Figures

Figure 1
Figure 1
Number of publications on regarding microcirculation in humans (source: Medline; search term 'microcirculation' limited to human data).
Figure 2
Figure 2
A multitude of factors potentially imparing microcirculatory perfusion in sepsis.
Figure 3
Figure 3
The shunting theory of sepsis accounts for the condition in which apparently adequate oxygen delivery is not successful in delivering oxygen to microcirculatory weak units that are shunted. This leads to an oxygen extraction deficit of these shunted units with raised levels of venous partial pressure of CO2, lactate and gastric CO2, whereas input oxygen delivery seems adequate. Vasodilation would be expected to recruit these shunted units by increasing the driving pressure to the microcirculation and possibly to these shunted units.
Figure 4
Figure 4
Orthogonal polarization spectral imaging technique (a) built into a simple hand-held device (b).
See this image and copyright information in PMC

Comment in

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