open access

Vol 48, No 4 (2016)
Review articles
Published online: 2016-09-21
Submitted: 2016-07-26
Accepted: 2016-09-18
Get Citation

Sepsis and septic shock-is a microcirculation a main player?

Małgorzata Lipinska-Gediga
DOI: 10.5603/AIT.a2016.0037
·
Pubmed: 27660252
·
Anaesthesiol Intensive Ther 2016;48(4):261-265.

open access

Vol 48, No 4 (2016)
Review articles
Published online: 2016-09-21
Submitted: 2016-07-26
Accepted: 2016-09-18

Abstract

Shock, defined at a cellular level, is a condition in which oxygen delivery to the cells is not sufficient to sustain cellular activity and support organ function. The central role of microcirculation in providing oxygen to the cells makes it of prime importance in determining organ function. In sepsis and septic shock, macrocirculatory alterations and microcirculatory dysfunction participate concurrently in the pathophysiology of organ failure. Haemodynamic coherence in shock is a condition in which normalization of systemic haemodynamic variables results in simultaneous amelioration in the perfusion of the microcirculation and restoration of tissue oxygenation as a final result. Septic shock is most frequently characterized by a lack of microcirculatory recruitment despite of macrocirculatory successful resuscitation. The lack of haemodynamic coherence between macrocirculation and microcirculation in septic patients results in treatment failure and increased mortality. The monitoring of microcirculation and the effects of its changes are an important area of future clinical research and treatment modification.

Abstract

Shock, defined at a cellular level, is a condition in which oxygen delivery to the cells is not sufficient to sustain cellular activity and support organ function. The central role of microcirculation in providing oxygen to the cells makes it of prime importance in determining organ function. In sepsis and septic shock, macrocirculatory alterations and microcirculatory dysfunction participate concurrently in the pathophysiology of organ failure. Haemodynamic coherence in shock is a condition in which normalization of systemic haemodynamic variables results in simultaneous amelioration in the perfusion of the microcirculation and restoration of tissue oxygenation as a final result. Septic shock is most frequently characterized by a lack of microcirculatory recruitment despite of macrocirculatory successful resuscitation. The lack of haemodynamic coherence between macrocirculation and microcirculation in septic patients results in treatment failure and increased mortality. The monitoring of microcirculation and the effects of its changes are an important area of future clinical research and treatment modification.

Get Citation

Keywords

sepsis; microcirculation; tissue perfusion; endothelium

About this article
Title

Sepsis and septic shock-is a microcirculation a main player?

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 48, No 4 (2016)

Pages

261-265

Published online

2016-09-21

DOI

10.5603/AIT.a2016.0037

Pubmed

27660252

Bibliographic record

Anaesthesiol Intensive Ther 2016;48(4):261-265.

Keywords

sepsis
microcirculation
tissue perfusion
endothelium

Authors

Małgorzata Lipinska-Gediga

References (33)
  1. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801–810.
  2. Spanos A, Jhanji S, Vivian-Smith A, et al. Early microvascular changes in sepsis and severe sepsis. Shock. 2010; 33(4): 387–391.
  3. Hernandez G, Bruhn A, Ince C. Microcirculation in sepsis: new perspectives. Curr Vasc Pharmacol. 2013; 11(2): 161–169.
  4. Gediga ML. Endothelium as A Part of Septic Multiple Organ Dysfunction Syndrome (Mods)- Is Endocan an Answer? Journal of Clinical & Cellular Immunology. 2015; 06(01).
  5. Steinberg BE, Goldenberg NM, Lee WL. Do viral infections mimic bacterial sepsis? The role of microvascular permeability: A review of mechanisms and methods. Antiviral Res. 2012; 93(1): 2–15.
  6. Reitsma S, Slaaf DW, Vink H, et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch. 2007; 454(3): 345–359.
  7. Donati A, Domizi R, Damiani E, Adrario E, Pelaia P, Ince C: From macrohemodynamic to microcirculation. Crit Care Res Pract . http://dx.doi.org/10.1155/2013/892710 (2013).
  8. De Backer D, Orbegozo Cortes D, Donadello K, et al. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence. 2014; 5(1): 73–79.
  9. Marechal X, Favory R, Joulin O, et al. Endothelial glycocalyx damage during endotoxemia coincides with microcirculatory dysfunction and vascular oxidative stress. Shock. 2008; 29(5): 572–576.
  10. Ince C. Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2015; 19 Suppl 3: S8.
  11. Vellinga NAR, Boerma EC, Koopmans M, et al. microSOAP Study Group. International study on microcirculatory shock occurrence in acutely ill patients. Crit Care Med. 2015; 43(1): 48–56.
  12. Edul VS, Ince C, Vazquez AR, et al. Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med. 2012; 40(5): 1443–1448.
  13. Sakr Y, Dubois MJ, De Backer D, et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004; 32(9): 1825–1831.
  14. Kolářová H, Ambrůzová B, Svihálková Šindlerová L, et al. Modulation of endothelial glycocalyx structure under inflammatory conditions. Mediators Inflamm. 2014; 2014: 694312.
  15. De Backer D, Creteur J, Preiser JC, et al. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002; 166(1): 98–104.
  16. Trzeciak S, McCoy JV, Phillip Dellinger R, et al. Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med. 2008; 34(12): 2210–2217.
  17. Chelazzi C, Villa G, Mancinelli P, et al. Glycocalyx and sepsis-induced alterations in vascular permeability. Crit Care. 2015; 19: 26.
  18. De Backer D, Ospina-Tascon G, Salgado D, et al. Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med. 2010; 36(11): 1813–1825.
  19. Groner W, Winkelman JW, Harris AG, et al. Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med. 1999; 5(10): 1209–1212.
  20. Goedhart PT, Khalilzada M, Bezemer R, et al. Sidestream Dark Field (SDF) imaging: a novel stroboscopic LED ring-based imaging modality for clinical assessment of the microcirculation. Opt Express. 2007; 15(23): 15101–15114.
  21. Boerma EC, Mathura KR, van der Voort PHJ, et al. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care. 2005; 9(6): R601–R606.
  22. Eriksson S, Nilsson J, Sturesson C. Non-invasive imaging of microcirculation: a technology review. Med Devices (Auckl). 2014; 7: 445–452.
  23. De Backer D, Donadello K. Assessment of microperfusion in sepsis. Minerva Anestesiol. 2015; 81(5): 533–540.
  24. Ospina-Tascon G, Neves AP, Occhipinti G, et al. Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med. 2010; 36(6): 949–955.
  25. Pottecher J, Deruddre S, Teboul JL, et al. Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med. 2010; 36(11): 1867–1874.
  26. Jhanji S, Stirling S, Patel N, et al. The effect of increasing doses of norepinephrine on tissue oxygenation and microvascular flow in patients with septic shock. Crit Care Med. 2009; 37(6): 1961–1966.
  27. Dubin A, Pozo MO, Casabella CA, et al. Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study. Crit Care. 2009; 13(3): R92.
  28. Boerma EC, Koopmans M, Konijn A, et al. Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: a double-blind randomized placebo controlled trial. Crit Care Med. 2010; 38(1): 93–100.
  29. Hernandez G, Bruhn A, Luengo C, et al. Effects of dobutamine on systemic, regional and microcirculatory perfusion parameters in septic shock: a randomized, placebo-controlled, double-blind, crossover study. Intensive Care Med. 2013; 39(8): 1435–1443.
  30. Zangrillo A, Putzu A, Monaco F, et al. Levosimendan reduces mortality in patients with severe sepsis and septic shock: A meta-analysis of randomized trials. J Crit Care. 2015; 30(5): 908–913.
  31. Morelli A, Donati A, Ertmer C, et al. Levosimendan for resuscitating the microcirculation in patients with septic shock: a randomized controlled study. Crit Care. 2010; 14(6): R232.
  32. Papp Z, Édes I, Fruhwald S, et al. Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan. Int J Cardiol. 2012; 159(2): 82–87.
  33. Morelli A, Passariello M, Singer M. Inotropic Support in the Treatment of Septic Myocardial Dysfunction: Pathophysiological Implications Supporting the Use of Levosimendan. Annual Update in Intensive Care and Emergency Medicine 2014. 2014: 407–419.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl