title: [Mitochondrial and microcirculatory distress syndrome in the critical patient. Therapeutic implications].
abstract: Mitochondrial and microcirculatory distress syndrome (MMDS) can occur during systemic inflammatory response syndrome (SIRS), and is characterized by cytopathic tissue hypoxia uncorrected by oxygen transport optimization, and associated with an acquired defect in the use of oxygen and energy production in mitochondria, leading to multiple organ dysfunction (MOD). We examine the pathogenesis of MMDS, new diagnostic methods, and recent therapeutic approaches adapted to each of the three phases in the evolution of the syndrome. In the initial phase, the aim is prevention and early reversal of mitochondrial dysfunction. Once the latter is established, the aim is to restore flow of the electron chain, mitochondrial respiration, and to avoid cellular energy collapse. Finally, in the third (resolution) stage, treatment should focus on stimulating mitochondrial biogenesis and the repair or replacement of damaged mitochondria.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario San Juan, San Juan, Alicante, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Navarrete
authors.forename: M C
authors.initials: MC
authors.lastname: Cerdeño
authors.forename: M C
authors.initials: MC
authors.lastname: Serra
authors.forename: R
authors.initials: R
authors.lastname: Conejero
mesh_terms: D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use; D015687:Cell Hypoxia; D018450:Disease Progression; D004579:Electron Transport / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006439:Hemodynamics; D006605:Hibernation; D006801:Humans; D007036:Hypothermia, Induced; D008833:Microcirculation / Q000502:physiology*; D008928:Mitochondria / Q000187:drug effects / Q000502:physiology; D028361:Mitochondrial Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D023421:Models, Animal; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D009569:Nitric Oxide / Q000502:physiology / Q000627:therapeutic use; D010085:Oxidative Phosphorylation / Q000187:drug effects; D017382:Reactive Oxygen Species; D013577:Syndrome; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000503:physiopathology
chemical_list: D000975:Antioxidants; D016166:Free Radical Scavengers; D017382:Reactive Oxygen Species; D009569:Nitric Oxide
keywords: Antioxidant therapy; Cytopathic hypoxia; Disfunción múltiple de órganos; Especies reactivas de oxígeno; Hipoxia citopática; Mitochondrial and microcirculatory distress syndrome; Multiple organ dysfunction; Nitric oxide; Reactive oxygen species; Systemic inflammatory response syndrome; Síndrome de distrés mitocondrial y de la microcirculación; Síndrome de respuesta inflamatoria sistémica; Terapia antioxidante; Óxido nítrico