title: The microcirculation as a diagnostic and therapeutic target in sepsis.
abstract: The microcirculation is defined as the smallest vessels where gas and nutrient exchange with tissues takes place. One of its primary functions is to ensure adequate oxygen delivery to meet the oxygen demands of tissue cells. Previous data from clinical and experimental studies and the recent development of new imaging modalities, such as Orthogonal Polarization Spectral videomicroscopy and Sidestream Dark Field imaging, have helped to identify the crucial role that microcirculation plays in sepsis. If not corrected, microcirculatory dysfunction can lead to respiratory distress in tissue cells and subsequent organ failure, even in the absence of global hemodynamic deficiency. In the present review, we will address past and recent developments regarding the role of the microcirculation as an important target in the pathogenesis of sepsis and its progression to multiple organ failure. Accordingly, we identify the microcirculation as an important diagnostic and therapeutic target for treatment in sepsis.
authors.affiliation: Department of Surgical and Medical Critical Care, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nencioni
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
mesh_terms: D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D012772:Shock, Septic / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
references.citation: J Clin Invest. 2005 Aug;115(8):2277-86
references.pmid: 16075063
references.citation: Br J Anaesth. 2007 Feb;98(2):163-75
references.pmid: 17251210
references.citation: Curr Opin Crit Care. 2005 Jun;11(3):240-4
references.pmid: 15928473
references.citation: J Vasc Res. 2002 Jul-Aug;39(4):368-72
references.pmid: 12187127
references.citation: Crit Care. 2006;10(6):R157
references.pmid: 17101035
references.citation: Shock. 1998 Oct;10(4):292-7
references.pmid: 9788662
references.citation: Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104
references.pmid: 12091178
references.citation: J Pathol. 2000 Feb;190(3):373-86
references.pmid: 10685071
references.citation: Chest. 2001 Sep;120(3):923-7
references.pmid: 11555530
references.citation: Br J Anaesth. 2008 Jan;100(1):55-65
references.pmid: 17982168
references.citation: Crit Care Med. 1993 Feb;21(2):218-23
references.pmid: 8428472
references.citation: N Engl J Med. 2001 Nov 8;345(19):1368-77
references.pmid: 11794169
references.citation: Crit Care Med. 2007 Apr;35(4):1055-60
references.pmid: 17334238
references.citation: N Engl J Med. 2005 Sep 29;353(13):1332-41
references.pmid: 16192478
references.citation: Crit Care Med. 2005 Feb;33(2):368-72
references.pmid: 15699841
references.citation: Crit Care Med. 2006 Dec;34(12 Suppl):S447-53
references.pmid: 17114976
references.citation: Intensive Care Med. 2002 Sep;28(9):1208-17
references.pmid: 12209267
references.citation: Lancet. 2002 Nov 2;360(9343):1395-6
references.pmid: 12423989
references.citation: Circ Res. 2000 Apr 14;86(7):774-8
references.pmid: 10764411
references.citation: Cardiovasc Res. 1996 Oct;32(4):752-63
references.pmid: 8915193
references.citation: Shock. 2008 Apr;29(4):452-7
references.pmid: 18598002
references.citation: Crit Care Med. 2004 Sep;32(9):1825-31
references.pmid: 15343008
references.citation: Crit Care Med. 2006 Jul;34(7):1918-24
references.pmid: 16715034
references.citation: Physiol Genomics. 2004 Nov 17;19(3):247-54
references.pmid: 15548831
references.citation: N Engl J Med. 2001 Mar 8;344(10):699-709
references.pmid: 11236773
references.citation: Intensive Care Med. 1998 Dec;24(12):1257-63
references.pmid: 9885877
references.citation: J Trauma. 1994 May;36(5):720-5
references.pmid: 7514673
references.citation: Crit Care. 2003 Oct;7(5):359-73
references.pmid: 12974969
references.citation: Ann Emerg Med. 2007 Jan;49(1):88-98, 98.e1-2
references.pmid: 17095120
references.citation: Crit Care. 2005;9 Suppl 4:S13-9
references.pmid: 16168069
references.citation: Proc Natl Acad Sci U S A. 1998 Jun 23;95(13):7631-6
references.pmid: 9636201
references.citation: Crit Care Med. 2004 Apr;32(4):1011-7
references.pmid: 15071394
references.citation: Crit Care Med. 2003 Jun;31(6):1659-67
references.pmid: 12794401
references.citation: Proc Natl Acad Sci U S A. 2003 Jun 24;100(13):7996-8001
references.pmid: 12808136
references.citation: J Clin Invest. 1994 Nov;94(5):2077-83
references.pmid: 7962554
references.citation: Acad Emerg Med. 2008 May;15(5):399-413
references.pmid: 18439194
references.citation: Crit Care Med. 2000 May;28(5):1290-4
references.pmid: 10834667
references.citation: Crit Care Med. 2001 Jul;29(7):1343-9
references.pmid: 11445683
references.citation: Crit Care Med. 2003 Jan;31(1):203-10
references.pmid: 12545016
references.citation: Crit Care Med. 2003 Feb;31(2):462-7
references.pmid: 12576952
references.citation: Crit Care. 2006;10(5):228
references.pmid: 16953900
references.citation: Intensive Care Med. 2002 Mar;28(3):265-71
references.pmid: 11904654
references.citation: Crit Care. 2006;10(4):221
references.pmid: 16879732