Response of the Microcirculation: Tissue Oxygenation

  • G. I. J. M. Beerthuizen

Abstract

The microcirculation can be defined as the circulation between the arterioles and venules; it enables direct flow to the cells. The microcirculation is different from the macrocirculation, because it is not totally enclosed in tubular structures. The microcirculation consists of arterioles 50–100 μm in diameter. This part is under nervous and humoral control and is the main pressure-regulating system of the microcirculation. The arterioles usually terminate in the capillaries, but they can communicate directly via arteriovenous shunts to the veins. Flow is unidirectional. Capillaries 4–15 μm in diameter, have a wall thickness of one endothelial cell and no innervation. Blood flow in these is bidirectional. The postcapillary venules have a diameter of 8–30 μm followed by collecting veins with a diameter of more than 100 μm, with several layers of smooth muscle and no valves. The capillaries allow exchange of gases (O2, CO2) and metabolic substances. The microcirculation has two ways to return to the macrocirculation, one through the venous system, the other through the lymphatics. The flow in the capillaries can be directional or nonexistent, thereby influencing the exchange of oxygen and metabolic substances to the cells. It is therefore possible to have a normal macrocirculation and a disturbed microcirculation reflected in lactic acidosis and eventually cell death.

Keywords

Permeability Catheter Depression Ischemia Platinum 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abraham E (1984) Continuous conjunctival and transcutaneous oxygen tension monitoring during resuscitation in a patient. Resuscitation 12:207–211.PubMedCrossRefGoogle Scholar
  2. Beerthuizen GIJM, Goris RJA, van der Kley AJ, Kimmich HP, Kreuzer F (1986) Early detection of burn shock by muscle oxygen pressure assessment. Bull Clin Rev Burn Inj 3:29–32.Google Scholar
  3. Beerthuizen GIJM, Goris RJA, Beijer HJM, Charbon GA (1987) Differences in regional oxygen supply, oxygen consumption and blood flow during the onset of E. coli, sepsis. Prog Clin Biol Res 236A:495–502.PubMedGoogle Scholar
  4. Beerthuizen GIJM, Goris RJA, Kreuzer FJA (1989) Early detection of shock in critically ill patients by skeletal muscle PO2 assessment. Arch Surg 124:853–855.PubMedCrossRefGoogle Scholar
  5. Beerthuizen GIJM, Goris RJA, Kreuzer FJA (1989) Is skeletal muscle PO2 related to the severity of multiple organ failure and survival in critically ill patients? Prog Clin Biol Res 308:137–142.PubMedGoogle Scholar
  6. Cain SM (1984) Supply dependency of oxygen uptake in ARDS — myth or reality? (review) Am J Med Sci 288:119.PubMedCrossRefGoogle Scholar
  7. Carrol G, Snyder J (1982) Hyperdynamic severe intravascular sepsis depends on fluid administration in cynomolgus monkeys. Am J Physiol 52:16–20.Google Scholar
  8. Cerra FB (1985) The systemic septic response: multiple systems organ failure. Crit Care Clin 1:591–607.PubMedGoogle Scholar
  9. Chang N, Goodson WH, Gottrup H, Hunt HK (1983) Direct measurement of wound and tissue oxygen tissue in postoperative patients. Ann Surg 197:470–478.PubMedCrossRefGoogle Scholar
  10. Chappell TR, Rubin LJ, Markham RV et al (1985) Independence of oxygen consumption and systemic oxygen transport in patients with either stable pulmonary hypertension or refractory left ventricular failure. Am Rev Respir Dis 128:30–38.Google Scholar
  11. Danek SJ, Lynch JP, Weg JG, Dantzker DR (1980) The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am Rev Respir Dis 122:387–395.PubMedGoogle Scholar
  12. Davies PW, Brink F (1942) Microelectrodes for measuring local oxygen tension in animal tissue. Rev Sci Instrum 13:524–533.CrossRefGoogle Scholar
  13. Duling BR (1980) Local control of microvascular function: role in tissue oxygen supply. Annu Rev Physiol 42:373–382.PubMedCrossRefGoogle Scholar
  14. Goeckenjan G, Strasser K (1977) Relation of transcutaneous to arterial PO2 in hypoxaemia, normoxaemia and hyperoxaemia. Investigations in adults with normal circulation and in patients with circulatory insufficiency. Biotelemetry 4:77–87.PubMedGoogle Scholar
  15. Goris RJA, van der Kleij AJ, Beerthuizen G, Kreuzer FJA, Kimmich HP, Koning de J (1984) Early detection of E. coli, sepsis by muscle PO2 assessment. Bull Clin Rev Burn Inj 1:17–19.Google Scholar
  16. Goris RJA, Boekhorstte ThPA, Nuytinck JKS, Gimbrere JSF (1985) Multiple-organ failure. Generalized autodestructive inflammation? Arch Surg 120:1109–1115.PubMedCrossRefGoogle Scholar
  17. Gosain A, Rabkin J, Reymond JP (1991) Tissue oxygen tension and other indicators of blood loss or organ perfusion during graded hemorrhage. Surgery 109:523–532.PubMedGoogle Scholar
  18. Gottrup F, Gellett S, Kirkegaard L, Hansen ES, Johansen G (1989) Effect of hemorrhage and resuscitation on subcutaneous, conjunctival, and transcutaneous oxygen tension in relation to hemodynamic variables. Crit Care Med 17:904–907.PubMedCrossRefGoogle Scholar
  19. Gow BS (1980) Circulatory correlates: vascular impedance, resistance, and capacity. In: Bohr DF, Somlyo AP, Sparks HV (eds) The cardiovascular system. American Physiological Society, Bethesda, pp 353–409 (Handbook of physiology, vol 2).Google Scholar
  20. Granger HJ, Goodman AH, Granger DN (1976) Role of resistance and exchange vessels in local microvascular control of skeletal muscle oxygenation in the dog. Circ Res 38:379–385.PubMedGoogle Scholar
  21. Greene NM (1966) Tissue oxygen tension in the anesthetized patient. Arch Surg 92:164–177.PubMedCrossRefGoogle Scholar
  22. Gutierrez G (1986) The rate of oxygen release and its effect on capillary O2 tension: a mathematical analysis. Respir Physiol 63:79–96.PubMedCrossRefGoogle Scholar
  23. Hartmann M, Montgomery A, Jonsson et al (1991) Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and gastrointestinal intramucosal pH in pigs. Crit Care Med 19:205–210.PubMedCrossRefGoogle Scholar
  24. Hochachka PW (1986) Defense strategies against hypoxia and hypothermia. Science 231:234–241.PubMedCrossRefGoogle Scholar
  25. Huch A, Lubbers DW, Huch R (1973) Continuous intravascular PO2 measurement with catheter and cannula electrodes in newborn infants, adults and animals. Adv Exp Med Biol 37b:1113–1119.Google Scholar
  26. Iberti ThJ, Kelly KM, Gentili DR et al (1988) Effects of sodium bicarbonate in canine hemorrhagic shock. Crit Care Med 16:779–782.PubMedCrossRefGoogle Scholar
  27. Jardin F, Sportiche M, Bazin M et al (1981) Dobutamine: a hemodynamic evaluation in human septic shock. Crit Care Med 8:329.CrossRefGoogle Scholar
  28. Jobsis FF (1977) Noninvasive infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 198:1264.PubMedCrossRefGoogle Scholar
  29. Kaufman BS, Rackow EC, Falk JL (1984) The relationship between oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 85:336.PubMedCrossRefGoogle Scholar
  30. Kessler M. Grunewald (1969) Possibilities of measuring oxygen pressure fields in tissue by multiwire platinum electrodes. Prog Respir Res 3:147.Google Scholar
  31. Kreuzer F, Cain SM (1985) Regulation of the peripheral vasculature and tissue oxygenation in health and disease. Crit Care Clin 1:453–470.PubMedGoogle Scholar
  32. Kreuzer F, Kimmich HP, Brezina M (1980) Polarographic determination of oxygen in biological materials. In: Koryta J (ed) Medical and biological applications electrochemical devices. Wiley, Chichester, pp 173–261.Google Scholar
  33. Krogh A (1919) The number and distribution of capillaries in muscles with calculation of the oxygen pressure necessary for supplying the tissue. J Physiol (Lond) 52:409–415.Google Scholar
  34. Landau SE, Alexander RS, Powers SR, Stratton HH, Goldfarb RD (1980) Tissue oxygen exchange and reactive hyperemia following microembolization. J Surg Res 32:38–43.CrossRefGoogle Scholar
  35. Lubbers DW (1981) Noninvasive monitoring of blood gases. Introduction. In: Kimmich HP (ed) Monitoring of vital parameters during extracorporeal circulation. Proceedings of the international conference, Nijmegen. Karger, Basel, pp 177–186.Google Scholar
  36. Makisalo HJ, Soini HO, Nordin AJ et al (1990) Effects of bicarbonate therapy on tissue oxygenation during resuscitation of hemorrhagic shock. Crit Care Med 1989, 17(11):1170–1174.CrossRefGoogle Scholar
  37. Mohsenifar S, Amin D, Jasper AC et al (1987) Dependence of oxygen consumption on oxygen delivery in patients with chronic congestive heart failure. Chest 93:447–450.CrossRefGoogle Scholar
  38. Niinikoski J (1977) Tissue oxygenation in hypovolemic shock. Ann Clin Res 9:151–156.PubMedGoogle Scholar
  39. Peabody JL, Gregory GA, Willis MM, Tooley WH (1978) Transcutaneous oxygen tension in sick infants. Am Rev Respir Dis 118:83–87.PubMedGoogle Scholar
  40. Rakusan K (1971) Oxygen in the heart muscle. Thomas, Springfield, p 39.Google Scholar
  41. Rooth G, Hedstrand U, Tyden H, Ogren C (1976) The validity of the transcutaneous oxygen tension method in adults. Crit Care Med 4:162–165.PubMedCrossRefGoogle Scholar
  42. Shah DM, Newell JC, Saba TM (1981) Defects in peripheral oxygen utilization following trauma and shock. Arch Surg 116:1277.PubMedCrossRefGoogle Scholar
  43. Shoemaker WC, Reinhard JM (1973) Tissue perfusion defects in shock and trauma states. Surg Gynecol Obstet 137:980–986.PubMedGoogle Scholar
  44. Shoemaker WC, Appel PL, Kram HB (1988) Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med 16:1117–1120.PubMedCrossRefGoogle Scholar
  45. Smith M, Abraham E (1986) Conjunctival oxygen tension monitoring during hemorrhage. J Trauma 26:217–224.PubMedCrossRefGoogle Scholar
  46. Snyder JV, Carroll GC (1982) Tissue oxygenation: a physiologic approach to a clinical problem. Curr Probl Surg 19:650–719.PubMedCrossRefGoogle Scholar
  47. Tremper KK, Shoemaker WC (1981) Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock. Crit Care Med 9:706–709.PubMedCrossRefGoogle Scholar
  48. Van der Kleij AJ, de Koning J, Beerthuizen G, Goris RJA, Kreuzer F, Kimmich HP (1983) Early detection of hemorrhagic hypovolemia by muscle oxygen pressure assessment: preliminary report. Surgery 93:518–524.PubMedGoogle Scholar
  49. Versmold HT, Linderkamp O, Holzmann M, Strohhacker I, Riegel KP (1978) Limits of tcPO2 monitoring in sick neonates: relation to blood pressure, blood volume, peripheral blood flow and acid bases status. Acta Anaesthesiol Scand [Suppl] 68:88–90.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • G. I. J. M. Beerthuizen
    • 1
  1. 1.Martini-HospitalGroningenThe Netherlands

Personalised recommendations