Changes in Systemic Microvascular Permeability in Sepsis and Septic Shock

Abstract

Generalized soft tissue edema both in dependent and nondependent parts of the body is a remarkable feature of severe sepsis and septic shock. Usually, septic patients need substantial intravascular volume replacement, much greater than could be anticipated on the basis of measurable fluid losses [3]. Fluid balances are strongly positive in many cases to become negative when the patient recovers, a tendency which is often not observed in nonsurvivors [15]. Marked persistent peripheral edema may therefore be an ominous prognostic sign. Tissue edema may have a number of serious clinical sequelae like generalized organ dysfunction, interference with oxygen diffusion from the intravascular compartment to the cell (longer diffusion distances) and abnormalities in drug metabolism due to changes in the volume of distribution [3]. Several mechanisms can be involved in the formation of edema in septic patients. Microvascular fluid exchange is governed by the Starling forces [11, 13].