Microcirculatory dysfunction and tissue oxygenation in critical illness
Severe sepsis is defined by organ failure, often of the kidneys, heart, and brain. It has been proposed that inadequate delivery of oxygen, or insufficient extraction of oxygen in tissue, may explain organ failure. Despite adequate maintenance of systemic oxygen delivery in septic patients, their mo...
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Published in | Acta anaesthesiologica Scandinavica Vol. 59; no. 10; pp. 1246 - 1259 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Blackwell Publishing Ltd
01.11.2015
Wiley Subscription Services, Inc John Wiley and Sons Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Severe sepsis is defined by organ failure, often of the kidneys, heart, and brain. It has been proposed that inadequate delivery of oxygen, or insufficient extraction of oxygen in tissue, may explain organ failure. Despite adequate maintenance of systemic oxygen delivery in septic patients, their morbidity and mortality remain high.
The assumption that tissue oxygenation can be preserved by maintaining its blood supply follows from physiological models that only apply to tissue with uniformly perfused capillaries. In sepsis, the microcirculation is profoundly disturbed, and the blood supply of individual organs may therefore no longer reflect their access to oxygen.
We review how capillary flow patterns affect oxygen extraction efficacy in tissue, and how the regulation of tissue blood flow must be adjusted to meet the metabolic needs of the tissue as capillary flows become disturbed as observed in critical illness. Using the brain, heart, and kidney as examples, we discuss whether disturbed capillary flow patterns might explain the apparent mismatch between organ blood flow and organ function in sepsis. Finally, we discuss diagnostic means of detecting capillary flow disturbance in animal models and in critically ill patients, and address therapeutic strategies that might improve tissue oxygenation by modifying capillary flow patterns. |
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Bibliography: | Danish Ministry of Science, Technology and Innovation's University Investment Grant ArticleID:AAS12581 istex:6E12B9F13098D218C19CA81921C200C79E328F29 Danish National Research Foundation ark:/67375/WNG-6ZRRX9XW-C Conflicts of interest This study was supported by the Danish National Research Foundation (LØ, KM, SNJ) and by the Danish Ministry of Science, Technology and Innovation's University Investment Grant (LØ, AT, NKI, MSJ, KM, SNJ). The authors declare that they have no conflicts of interest. Funding ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
ISSN: | 0001-5172 1399-6576 |
DOI: | 10.1111/aas.12581 |