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Microcirculation in Patients with Sepsis: From Physiology to Interventions

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Annual Update in Intensive Care and Emergency Medicine 2020

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Patient survival depends on determining the cause of the underlying condition and treating the pathology, as well as supportive care until restoration of normal physiology. Resuscitation guidelines have long been focused on macrohemodynamic variables, such as cardiac output, as well as indirect measures of blood flow and tissue perfusion, such as lactate. In recent years, interest has been develo** in the assessment and management of the microcirculation. The early goals of resuscitation in circulatory shock are to restore global blood flow, oxygen delivery, and organ perfusion pressure with the ultimate aim of improving microcirculatory perfusion and cellular oxygen metabolism. The aim of this chapter is to outline the principles of the microcirculation, microcirculatory dysfunction in sepsis, and therapies to improve microcirculatory function and tissue perfusion. Sepsis is characterized by macrocirculatory alterations such as relative hypovolemia, a decrease in vascular tone, myocardial depression, a heterogeneous pattern of blood flow in microcirculation, as well as the incapacity of cells to extract and adequately use oxygen. With newer and more sophisticated monitoring techniques, the microcirculation can be used to guide resuscitative efforts towards more targeted therapies. In addition to clinical examination and biochemical markers as methods of assessment, handheld vital microscopes allow direct visualization of capillaries and a number of indices and classifications have been developed which show good inter-observer reproducibility. Despite the advances in our understanding of microcirculatory dysfunction there remains a deficit in knowledge regarding how best to treat it.

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Authors and Affiliations

  1. Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, Ireland

    B. Cantan & I. Martín-Loeches

  2. Hospital Clinic, Universidad de Barcelona, CIBERes, Barcelona, Spain

    I. Martín-Loeches

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  1. B. Cantan
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  2. I. Martín-Loeches
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Correspondence to I. Martín-Loeches .

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  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Cantan, B., Martín-Loeches, I. (2020). Microcirculation in Patients with Sepsis: From Physiology to Interventions. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_20

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  • DOI: https://doi.org/10.1007/978-3-030-37323-8_20

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  • Online ISBN: 978-3-030-37323-8

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