Skip to main content
SpringerLink
Log in

Microvascular Regulation of Tissue Oxygenation in Sepsis

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine 1998

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1998))

  • 193 Accesses

Abstract

Sepsis and its related syndromes develop frequently in hospitalized patients, with an associated mortality of 10–20%. In the presence of circulatory failure, this figure rises to over 60% and may account for up to 200,000 deaths per annum in the USA alone [1]. Most patients succumb to a multiple organ dysfunction syndrome (MODS) rather than hypotension per se [2], but the reasons for this are not clear. Sepsis is known to disrupt microcirculatory flow and nutrient exchange, and an impaired response to endogenous and exogenous pressor agents is often reported [3]. Intravascular leukaggregation, abnormal red blood cell deformability, increased microvascular permeability, interstitial protein loss and tissue edema are frequently observed [4]. This systemic inflammatory response is promoted not only by reduced perfusion of nutrient vessels, but also from pro-inflammatory mediators released from activated, sequestered leukocytes, and activated macrophages, platelets and endothelial cells. It has been hypothesized that endothelial injury exacerbates maldistribution of regional blood flow leading to cellular hypoxia and vital organ dysfunction. Various injurious substances as well as several microbacteria toxins (e.g., peptoglycans from Gram-positive bacteria) may initiate this response. However, the most severe septic microvascular inflammatory responses are observed with Gram-negative bacteria, or more specifically the cell wall component, endotoxin.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Control CfD (1990) Increase in National Hospital discharge survey rates for septicemia - United States, 1979–1987. MM WR 39: 31–34

    Google Scholar 

  2. St John RC, Dorinsky PM (1994) An overview of multiple organ dysfunction syndrome. J Lab Clin Med 124: 478–483

    PubMed  CAS  Google Scholar 

  3. Myers PR, Zhong Q, Jones JJ, Tanner MA, Adams HR, Parker JL (1995) Release of EDRF and NO in ex vivo perfused aorta: inhibition by in vivo E. coli endotoxemia. Am J Physiol 268: H955–H961

    CAS  Google Scholar 

  4. Curzen NP, Griffiths MJ, Evans TW (1994) Role of the endothelium in modulating the vascular response to sepsis. Clin Sci Colch 86: 359–374

    PubMed  CAS  Google Scholar 

  5. Raetz C (1990) Biochemistry of endotoxins. Ann Rev Biochem 59: 129–170

    Article  PubMed  CAS  Google Scholar 

  6. Nolan J (1989) Intestinal endotoxins as mediators of hepatic injury - an idea whose time has come again. Hepatology 10: 887–891

    Article  PubMed  CAS  Google Scholar 

  7. McCuskey R, Nishida J, Eguchi H (1995) Role of endotoxin in the hepatic microvascular inflam-matory response to ethanol. J Gastroenterol Hepatol 10 (suppl 1): 518–523

    Article  Google Scholar 

  8. Ruiter D, van der Maulen J, Brouwer A, et al (1981) Uptake by liver cells of endotoxin following its intravenous injection. Lab Invest 45: 38–45

    PubMed  CAS  Google Scholar 

  9. Noel R, Sato T, Mendez C, Johnson M, Pohlman T (1995) Activation of human endothelial cells by viable or heat-killed gram-negative bacteria requires soluble CD 14. Infect Immun 63: 4046–4053

    PubMed  CAS  Google Scholar 

  10. Ryan J, Morrison D (eds) (1992) Bacterial endotoxic lipopolysaccharides. II. Immunopharmacology and pathophysiology. CRC Press, Boca Raton

    Google Scholar 

  11. Szentivanyi E, Nowotny A, Friedman H (eds) (1986) Immunobiology and Immunopharmacology of bacterial endotoxins. Plenum Press, New York

    Google Scholar 

  12. Pallares LC, Evans TW (1992) Oxygen transport in the critically ill. Respir Med 86: 289–295

    Article  PubMed  CAS  Google Scholar 

  13. Fiddian Green RG, Haglund U, Gutierrez G, Shoemaker WC (1993) Goals for the resuscitation of shock. Crit Care Med 21 (suppl 2): S25–S31

    Article  PubMed  CAS  Google Scholar 

  14. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722

    Article  PubMed  CAS  Google Scholar 

  15. McKenna TM (1988) Enhanced vascular effects of cyclic GMP in septic rat aorta. Am J Physiol 23: R436–R442

    Google Scholar 

  16. Parker JL, Keller RS, DeFily DV, Laughlin MH, Novotny MJ, Adams HR (1991) Coronary vascular smooth muscle function in E. coli endotoxemia in dogs. Am J Physiol 260: H832–H842

    CAS  Google Scholar 

  17. Umans JG, Wylam ME, Samsel RW, Edwards J, Schumacker PT (1993) Effects of endotoxin in vivo on endothelial and smooth muscle function in rabbit and rat aorta. Am Rev Respir Dis 148: 1638–1645

    Article  PubMed  CAS  Google Scholar 

  18. Julou Schaeffer G, Gray GA, Fleming I, Schott C, Parratt JR, Stockt JC (1990) Loss of vascular responsiveness induced by endotoxin involves L-arginine pathway. Am J Physiol 259: H1038–H1043

    PubMed  CAS  Google Scholar 

  19. Schumacker PT, Kazaglis J, Connolly HV, Samsel RW, O’Connor MF, Umans JG (1995) Systemic and gut oxygen extraction during endotoxemia: role of nitric oxide synthesis. Am Rev Respir Crit Care Med 151: 107–115.

    CAS  Google Scholar 

  20. Spain DA, Wilson MA, Bar Natan MF, Garrison RN (1994) Nitric oxide synthase inhibition aggravates intestinal microvascular vasoconstriction and hypoperfusion of bacteremia. J Trauma 36: 720–725

    Article  PubMed  CAS  Google Scholar 

  21. Zhang H, De Jongh R, De Backer D, Checkaoui S, Vincent JL (1997) Effects of adrenergic agonists on hepatosplanchnic perfusion and oxygen extraction in endotoxic shock. Am J Resp Crit Care Med 155: A402 (Abst)

    Google Scholar 

  22. Wang P, Ba ZF, Chaudry IH (1995) Endothelium-dependent relaxation is depressed at the macro- and microcirculatory levels during sepsis. Am J Physiol 269: R988–R994

    PubMed  CAS  Google Scholar 

  23. Lubbe AS, Garrison RN, Cryer HM, Alsip NL, Harris PD (1992) EDRF as a possible mediator of sepsis-induced arteriolar dilation in skeletal muscle. Am J Physiol 262: H880–H887

    PubMed  CAS  Google Scholar 

  24. Cryer HM, Garrison RN, Kaebnick HW, Harris PD, Flint LM (1987) Skeletal microcirculatory responses to hyperdynamic Escherichia coli sepsis in unanesthetized rats. Arch Surg 122: 86–92

    Article  PubMed  CAS  Google Scholar 

  25. Garrison RN, Cryer HMd (1989) Role of the microcirculation in skeletal muscle during shock. Prog Clin Biol Res 299: 43–52

    PubMed  CAS  Google Scholar 

  26. Boczkowski J, Vicaut E, Aubier M (1992) In vivo effects of Escherichia coli sepsis in unanaesthetized rats. J Appl Physiol 72: 2219–2224

    PubMed  CAS  Google Scholar 

  27. Steeb GD, Wilson MA, Garrison RN (1992) Pentoxifylline preserves small-intestine microvascular blood flow during bacteremia. Surgery 112: 756–764

    PubMed  CAS  Google Scholar 

  28. Theuer C, Wilson MA, Steeb GD, Garrison RN (1993) Microvascular vasoconstriction and mucosal hypoperfusion of the rat small intestine during bacteremia. Circ Shock 40: 61–68

    PubMed  CAS  Google Scholar 

  29. Lam C, Tyml K, Martin C, Sibbald W (1994) Microvascular perfusion is impaired in a rat model of normotensive sepsis. J Clin Invest 94: 2077–2083

    Article  PubMed  CAS  Google Scholar 

  30. Hasibeder W, Germann R, Wolf H, et al (1996) Effects of short-term endotoxemia and dopamine on mucosal oxygenation in porcine jejunum. Am J Physiol 270: G667–G675

    PubMed  CAS  Google Scholar 

  31. Ruokonen E, Takala J, Kari A, Saxen H, Mertsola J, Hansen E (1993) Regional blood flow and oxygen transport in septic shock. Crit Care Med 21: 1296–1303

    Article  PubMed  CAS  Google Scholar 

  32. Cain S, Curtis S (1992) Systemic and regional oxygen uptake and lactate flux in endotoxic dogs resuscitated with dextran and dopexamine or dextran alone. Circ Shock 38: 173–181

    PubMed  CAS  Google Scholar 

  33. Shepherd A, Riedel G, Maxwell L, Kiel J (1984) Selective vasodilators redistribute intestinal blood flow and depress oxygen uptake. Am J Physiol 247: G377–G384

    PubMed  CAS  Google Scholar 

  34. Germann R, Haisjackl M, Schwarz B, et al (1997) Inotropic treatment and intestinal mucosal tissue oxygenation in a model of porcine endotoxemia. Crit Care Med 25: 1191–1197

    Article  PubMed  CAS  Google Scholar 

  35. Fiddian-Green R (1995) Gastric intramucosal pH, tissue oxygenation and acid base balance. Br J Anaesth 74: 591–606

    Article  PubMed  CAS  Google Scholar 

  36. Smithies M, Yee T, Jackson L, Beale R, Bihari D (1994) Protecting the gut and liver in the critically ill: effects of dopexamine. Crit Care Med 22: 789–795

    Article  PubMed  CAS  Google Scholar 

  37. Neviere R, Mathieu D, Chagnon JL, Lebleu N, Wattel F (1996) The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients. Am J Respir Crit Care Med 154: 1684–1688

    PubMed  CAS  Google Scholar 

  38. Greenbaum AR, Etherington PJ, Manek S, et al (1997) Measurements of oxygenation and perfusion in skeletal muscle using multiple microelectrodes. Muscle Res Cell Motil 18 (2): 149–159

    Article  CAS  Google Scholar 

  39. Kopp KH, Sinagowitz E, Muller H (1984) Oxygen supply of skeletal muscle in experimental endotoxic shock. Adv Exp Med Biol 169: 467–476

    PubMed  CAS  Google Scholar 

  40. Gutierrez G, Lund N, Palizas F (1991) Rabbit skeletal muscle pO2 during hypodynamic sepsis. Chest 99: 224–229

    Article  PubMed  CAS  Google Scholar 

  41. Astiz M, Rackow EC, Weil MH, Schumer W (1988) Early impairment of oxidative metabolism and energy production in severe sepsis. Circ Shock 26: 311–320

    PubMed  CAS  Google Scholar 

  42. Rosser DM, Stidwill RP, Jacobson D, Singer M (1995) Oxygen tension in the bladder epithelium rises in both high and low cardiac output endotoxemic sepsis. J Appl Physiol 79: 1878–1882

    PubMed  CAS  Google Scholar 

  43. Rosser DM, Stidwill RP, Jacobson D, Singer M (1996) Cardiorespiratory and tissue oxygen dose response to rat endotoxemia. Am J Physiol 271: H891–H895

    PubMed  CAS  Google Scholar 

  44. Sair M, Etherington PJ, Curzen NP, Winlove CP, Evans TW (1996) Tissue oxygenation and perfusion in endotoxemia. Am Physiol 271: H1620–H1625

    CAS  Google Scholar 

  45. Sair M, Anning PB, Winlove CP, Evans TW (1997) Tissue oxygenation 8c cardiovascular effects of endotoxaemia: Effects of volume resuscitation. Intensive Care Med 23 (Suppl 1):S93 (Abst)

    Google Scholar 

  46. Sair M, Anning PB, Winlove CP, Evans TW (1997) Tissue oxygenation & cardiovascular effects of endotoxaemia: Effects of NOS inhibition. Intensive Care Med 23 (Suppl 1):S92 (Abst)

    Google Scholar 

  47. Naumann CP, Ruetsch YA, Fleckenstein W, Fennema M, Erdmann W, Zach GA (1992) pO2-profiles in human muscle tissue as indicator of therapeutical effect in septic shock patients. Adv Exp Med Biol 317: 869–877

    Google Scholar 

  48. Boekstegers P, Weidenhofer S, Kapsner T, Werdan K (1994) Skeletal muscle partial pressure of oxygen in patients with sepsis. Crit Care Med 22: 640–650

    Article  PubMed  CAS  Google Scholar 

  49. Boekstegers P, Weidenhofer S, Pilz G, Werdan K (1991) Peripheral oxygen availability within skeletal muscle in sepsis and septic shock: comparison to limited infection and cardiogenic shock. Infection 19: 317–323

    Article  PubMed  CAS  Google Scholar 

  50. Reinhart K, Bloos F, Konig F, Hannemann L, Kuss B (1990) Oxygen transport variables and muscle tissue oxygenation in critically ill patients with and without sepsis. Adv Exp Med Biol 277: 861–864

    PubMed  CAS  Google Scholar 

  51. Lund N, de Asia RJ, Cladis F, Papadakos PJ, Thorborg PA (1995) Dopexamine hydrochloride in septic shock: effects on oxygen delivery and oxygenation of gut, liver, and muscle. J Trauma 38: 767–775

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. P. B. Anning
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Sair
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. W. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Clinical Director) (Clinical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Anning, P.B., Sair, M., Evans, T.W. (1998). Microvascular Regulation of Tissue Oxygenation in Sepsis. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1998. Yearbook of Intensive Care and Emergency Medicine, vol 1998. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72038-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-72038-3_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-63798-1

  • Online ISBN: 978-3-642-72038-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation