Microcirculatory dysfunction in sepsis: pathophysiology, clinical monitoring, and potential therapies.
Abnormal microvascular perfusion, including decreased functional capillary density and increased blood flow heterogeneity, is observed in early stages of the systemic inflammatory response to infection and appears to have prognostic significance in human sepsis. It is known that improvements in systemic hemodynamics are weakly correlated with the correction of microcirculatory parameters, despite an appropriate treatment of macrohemodynamic abnormalities. Furthermore, conventional hemodynamic monitoring systems available in clinical practice fail to detect microcirculatory parameter changes and responses to treatments, as they do not evaluate intrinsic events that occur in the microcirculation. Fortunately, some bedside diagnostic methods and therapeutic options are specifically directed to the assessment and treatment of microcirculatory changes. In the present review we discuss fundamental aspects of septic microcirculatory abnormalities, including pathophysiology, clinical monitoring, and potential therapies.
Laboratory for Clinical and Experimental Research in Vascular Biology, BioVasc, Biomedical Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; marcoslmiranda@gmail.com.
Marcos
M
Miranda
Internal Medicine Department, Andaraí Federal Hospital, Rio de Janeiro, RJ, Brazil; and.
Michelle
M
Balarini
Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil.
Daniella
D
Caixeta
Laboratory for Clinical and Experimental Research in Vascular Biology, BioVasc, Biomedical Center, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil;
Eliete
0000-0002-9621-8252
E
Bouskela
D000818:Animals; D015415:Biomarkers / Q000097:blood; D003935:Diagnostic Techniques, Cardiovascular; D006439:Hemodynamics; D006801:Humans; D008833:Microcirculation; D055806:Microvessels / Q000503:physiopathology*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D015398:Signal Transduction; D016896:Treatment Outcome
D015415:Biomarkers
microcirculation; microcirculatory monitoring; microvascular resuscitation; sepsis