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Intensive Care Medicine

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Open Access 01-12-2010 | Review

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Authors: E. Christiaan Boerma, Can Ince

Published in: Intensive Care Medicine | Issue 12/2010

Abstract

Purpose

The clinical use of vasoactive drugs is not only intended to improve systemic hemodynamic variables, but ultimately to attenuate derangements in organ perfusion and oxygenation during shock. This review aims (1) to discuss basic physiology with respect to manipulating vascular tone and its effect on the microcirculation, and (2) to provide an overview of available clinical data on the relation between vasoactive drugs and organ perfusion, with specific attention paid to recent developments that have enabled direct in vivo observation of the microcirculation and concepts that have originated from it.

Methods

A MedLine search was conducted for clinical articles in the English language over the last 15 years pertainig to shock, sepsis, organ failure, or critically ill patients in combination with vasoactive drugs and specific variables of organ perfusion/oxygenation (e.g., tonometry, indocyanine clearance, laser Doppler, and sidestream dark field imaging).

Results

Eighty original papers evaluating the specific relationship between organ perfusion/oxygenation and the use of vasoactive drugs were identified and are discussed in light of physiological theory of vasomotor tone.

Conclusions

Solid clinical data in support of the idea that increasing blood pressure in shock improves microcirculatory perfusion/oxygenation seem to be lacking, and such a concept might not be in line with physiological theory of microcirculation as a low-pressure vascular compartment. In septic shock no beneficial effect on microcirculatory perfusion above a mean arterial pressure of 65 mmHg has been reported, but a wide range in inter-individual effect seems to exist. Whether improvement of microcirculatory perfusion is associated with better patient outcome remains to be elucidated.

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Title: The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients
Authors: E. Christiaan Boerma
Can Ince
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1970-x

At a glance: The STEP trials

Springer Medicine

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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Other articles of this Issue 12/2010

Post-traumatic stress disorder after weaning from prolonged mechanical ventilation

Gas distribution in a two-compartment model ventilated in high-frequency percussive and pressure-controlled modes

Erratum to: A new automated method versus continuous positive airway pressure method for measuring pressure–volume curves in patients with acute lung injury

Propensity scores in intensive care and anaesthesiology literature: a systematic review

Praying for healthy minds and healthy bodies in ICU survivors

Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside