open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-20
Submitted: 2015-10-03
Accepted: 2015-11-17
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From cardiac output to blood flow auto-regulation in shock

Hollmann D. Aya, Andrea Carsetti, Simone Bazurro, Davide Bastoni, Manu L.N.G. Malbrain, Maurizio Cecconi
DOI: 10.5603/AIT.a2015.0077

open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-20
Submitted: 2015-10-03
Accepted: 2015-11-17

Abstract

Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of
the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at
a haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims to
review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential
therapeutic approaches for cardiovascular instability in patients in cardiovascular shock. Despite the recent advances
in haemodynamics, the mechanisms that control the vascular resistance and the venous return are not fully understood
in critically ill patients. The physical properties of the vascular wall, as well as the role of the mean systemic
filling pressure are topics that require further research. However, the haemodynamics do not totally explain the
physiopathology of cellular dysoxia, and several factors such as inflammatory changes at the microcirculatory level
can modify vascular resistance and tissue perfusion. Cellular vasoactive mediators and endothelial and glucocalix
damage are also involved in microcirculatory impairment. All the levels of the circulatory system must be taken into
account. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classic
haemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters is
essential but not sufficient to detect and treat patients in cardiovascular shock.

Abstract

Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of
the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at
a haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims to
review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential
therapeutic approaches for cardiovascular instability in patients in cardiovascular shock. Despite the recent advances
in haemodynamics, the mechanisms that control the vascular resistance and the venous return are not fully understood
in critically ill patients. The physical properties of the vascular wall, as well as the role of the mean systemic
filling pressure are topics that require further research. However, the haemodynamics do not totally explain the
physiopathology of cellular dysoxia, and several factors such as inflammatory changes at the microcirculatory level
can modify vascular resistance and tissue perfusion. Cellular vasoactive mediators and endothelial and glucocalix
damage are also involved in microcirculatory impairment. All the levels of the circulatory system must be taken into
account. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classic
haemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters is
essential but not sufficient to detect and treat patients in cardiovascular shock.

Get Citation

Keywords

Cardiac output and autoregulation in shock

About this article
Title

From cardiac output to blood flow auto-regulation in shock

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47 (2015): Special issue

Pages

56-62

Published online

2015-11-20

DOI

10.5603/AIT.a2015.0077

Keywords

Cardiac output and autoregulation in shock

Authors

Hollmann D. Aya
Andrea Carsetti
Simone Bazurro
Davide Bastoni
Manu L.N.G. Malbrain
Maurizio Cecconi

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