Time out for vasopressors in increased microvascular permeability?

Excerpt

Hypovolemia, resulting from blood or water loss, vasoplegia, or a capillary leak, is one of the most common reasons for shock states in the critically ill. Consequently, fluid replacement therapy is one of the cornerstones of the treatment in patients with trauma and/or septic shock. In addition, due to decreased peripheral vascular resistances in combination with altered microvascular blood flow, most frequently the ICU physician is also obliged to use vasoactive drugs in order to control hemodynamics and tissue perfusion. In this context, the question of the adequate perfusion pressure may assume crucial importance. In fact, according to the “two pores” theory for transcapillary fluid exchange, the rate of fluid escape from the vascular into the interstitial space depends on both the hydrostatic capillary pressure and the microvascular permeability [1]. …