[Therapeutic options to improve the microcirculation in sepsis and septic shock].
The severe impairment of the microcirculation plays a substantial role in the pathogenesis of severe sepsis and septic shock, and leads to multiple organ failure and death. Therapeutic strategies to resuscitate the microcirculatory blood flow and to improve the functional capillar density are therefore essential to surmount the microcirculatory pathology and to avoid tissue hypoxia. Based on reasonable scientific evidence, early fluid resuscitation directed by defined haemodynamic and metabolic goals (EGDT) as well as the application of activated protein C (rhAPC) according to the guidelines could be recommended. Dobutamine is the first choice to improve cardiac output and to overcome myocardial depression in septic shock whereas phosphodiesterase-III-inhibitors and levosimendane are still experimental options. Furthermore selective inhibitors of iNOS, nitroglycerol, as well as vasopressin have to be investigated relating to their specific effects on the microcirculation and their influence on survival in seevere sepsis and septic shock.
Ragaller
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Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus an der Medizinischen Fakultät der Technischen Universität Dresden, Fetscherstrasse 74, 01307 Dresden. MRagaller@ukd81.med.tu-dresden.de
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D001783:Blood Flow Velocity; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004784:Environmental Monitoring; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D012772:Shock, Septic / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D014664:Vasodilation
D002316:Cardiotonic Agents; D011486:Protein C; D011994:Recombinant Proteins; D004280:Dobutamine; D052247:Nitric Oxide Synthase Type II