Microvascular Alterations in Patients with Circulatory Failure

  • D. De Backer
  • J. Creteur
  • M. J. Dubois
Conference paper

Abstract

Many patients continue to die from acute circulatory failure despite improvement in whole body hemodynamics. Early optimization of oxygen transport in patients with septic shock can lead to a decrease in morbidity and mortality, but nevertheless a significant proportion of these patients will develop multiple organ failure (MOF) and will ultimately die [1]. Several factors can be implicated in the development of MOF including alterations in blood flow distribution between the various organs but also alterations in metabolic pathways (cytopathic hypoxia). Multiple studies have reported that an imbalance between oxygen demand and supply can occur in the splanchnic area [2, 3], but the most commonly used therapeutic interventions (fluids, inotopic agents, red blood cell [RBC] transfusions) have usually failed to improve regional blood flow alterations in septic patients [4, 5] so that survival was not improved. On the other hand, several studies indicated that metabolic pathways may be directly altered, so that giving more ‘fuel’ to the system would not result in any improvement in tissue oxygenation. Several data support the concept of cytopathic hypoxia. King et al. [6] reported that endotoxin impaired oxygen consumption in mucosal samples in polarographic air-saturated chambers, and related this effect to nitric oxide (NO). In humans, Brealey et al. [7] reported that cytochrome complex I is significantly altered in muscle biopsies obtained in patients with sepsis. Nevertheless, these alterations alone cannot explain all the features observed in patients with septic shock. First, if cytopathic hypoxia were prominent, therapeutic interventions such as early-goal oriented hemodynamic optimalization, as proposed by Rivers et al. [1], would probably not have been successful. Second, cytopathic hypoxia is not compatible with the numerous data reporting increased tissue CO2 in septic shock [4, 5, 9], as CO2 would be rapidly cleared if blood flow was adequate. Hence, it is very likely that all these alterations coexist, the respective part of each of them being undetermined.

Keywords

Septic Shock Severe Sepsis Respir Crit Microvascular Blood Flow Perfuse Capillary 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • D. De Backer
  • J. Creteur
  • M. J. Dubois

There are no affiliations available

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