Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock.
Multiple experimental and human trials have shown that microcirculatory alterations are frequent in sepsis. In this review, we discuss the various mechanisms that are potentially involved in their development and the implications of these alterations. Endothelial dysfunction, impaired inter-cell communication, altered glycocalyx, adhesion and rolling of white blood cells and platelets, and altered red blood cell deformability are the main mechanisms involved in the development of these alterations. Microcirculatory alterations increase the diffusion distance for oxygen and, due to the heterogeneity of microcirculatory perfusion in sepsis, may promote development of areas of tissue hypoxia in close vicinity to well-oxygenated zones. The severity of microvascular alterations is associated with organ dysfunction and mortality. At this stage, therapies to specifically target the microcirculation are still being investigated.
Department of Intensive Care; Erasme University Hospital; Université Libre de Bruxelles (ULB); Bruxelles, Belgium.
Daniel
D
De Backer
Department of Intensive Care; Erasme University Hospital; Université Libre de Bruxelles (ULB); Bruxelles, Belgium.
Diego
D
Orbegozo Cortes
Department of Intensive Care; Erasme University Hospital; Université Libre de Bruxelles (ULB); Bruxelles, Belgium.
Katia
K
Donadello
Department of Intensive Care; Erasme University Hospital; Université Libre de Bruxelles (ULB); Bruxelles, Belgium.
Jean-Louis
JL
Vincent
D002448:Cell Adhesion; D015687:Cell Hypoxia / Q000502:physiology*; D004727:Endothelium / Q000098:blood supply; D004912:Erythrocytes / Q000473:pathology; D019276:Glycocalyx; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D012772:Shock, Septic / Q000503:physiopathology*
endothelium; microcirculatory blood flow; organ failure; sepsis; tissue PCO2; tissue PO2; tonometry