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.

Estradiol receptors agonists induced effects in rat intestinal microcirculation during sepsis

“…We used CASP model, which appears (together with cecal ligation and puncture (CLP)) to be the best existing alternative for emulating human polymicrobial sepsis to date and could mimic the pathophysiologic consequences of sepsis (Hubbard et al, 2005;Traeger et al, in press). We found significant changes only in microcirculation; this observation agree with Dyson et al (Dyson et al, 2012), who suggested the uncoupling of macrovascular function and microvascular flow impairment during early sepsis, and that microcirculatory derangements may be present even in the absence of global hemodynamic deficiency (De Backer et al, 2010;Nencioni et al, 2009). This could be explained by various events occur at the microcirculatory, such as disturbed balance between vasoconstrictive and vasodilatory substances, microthrombi and, more frequently, plugs of leukocyte and erythrocyte.…”

Endothelial Dysfunction in Sepsis

“…In a septic shock model of peritonitis by cecal ligation and puncture in rats, Lam et al [42] used intravital videomicroscopy and showed that sepsis altered microvascular perfusion, with increased microcirculation flow heterogeneity and reduced functional capillary density. Therefore, microcirculation's dysfunction may appear as a major mechanism in the development of multiple organ failure [45]. Therefore, microcirculation's dysfunction may appear as a major mechanism in the development of multiple organ failure [45].…”

“…Sepsis is therefore responsible for an intense cellular activation; endothelial cells will amplify the inflammatory response by releasing proinflammatory cytokines, which contribute to spreading of microcirculatory injuries [45]. In a mouse endotoxemic shock model, Meziani et al [47] demonstrated that human serum albumin reduced endotoxemiainduced inflammation, by decreasing the up-regulation of I B , thus blunting the activation of NF-B.…”

Clinical review: Clinical imaging of the sublingual microcirculation in the critically ill - where do we stand?

“…Using OPS imaging we were the first to image the human brain microcirculation during surgery [21]. Since then, numerous studies have been undertaken in various clinical scenarios where cardiovascular function is at risk (for example, [1-3,7,8,10,11]).…”