Recruiting the microcirculation in septic shock

Excerpt

Mortality of critically ill patients is driven by severity of the insult, comorbidities, appropriate treatment, and organ failure. The pathophysiological mechanisms leading to organ failure during sepsis remain poorly understood. The direct toxicity of pro-inflammatory mediators and/or bacterial components and/or circulating particles released from damaged cells has been suggested to contribute to organ dysfunction. Alterations of microcirculatory perfusion were associated with organ failure severity and mortality in septic shock patients. Tissue perfusion is likely to play a role in the development of organ dysfunction either due to systemic or regional alterations. Interestingly, organ dysfunction may persist despite apparent restoration of systemic macrohemodynamic variables [1]. Optimal macrohemodynamic targets to perfuse and recruit the microvessels may vary, however, between patients and between vascular beds [2]. …