Therapeutic options to improve the microcirculation in sepsis and septic shock

The severe impairment of the microcirculation plays a substantial role in the pathogenesis of severe sepsis and septic shock, and leads to multiple organ failure and death. Therapeutic strategies to resuscitate the microcirculatory blood flow and to improve the functional capillar density are theref...

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Bibliographic Details
Published inHämostaseologie Vol. 27; no. 1; p. 59
Main Authors Ragaller, M, Theilen, H, Koch, T
Format Journal Article
LanguageGerman
Published Germany 01.02.2007
Subjects
Blood Flow Velocity
Cardiotonic Agents - therapeutic use
Dobutamine - therapeutic use
Environmental Monitoring
Humans
Microcirculation - physiology
Nitric Oxide Synthase Type II - metabolism
Protein C - therapeutic use
Recombinant Proteins - therapeutic use
Sepsis - blood
Sepsis - drug therapy
Sepsis - physiopathology
Shock, Septic - blood
Shock, Septic - drug therapy
Shock, Septic - physiopathology
Vasodilation
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Summary:The severe impairment of the microcirculation plays a substantial role in the pathogenesis of severe sepsis and septic shock, and leads to multiple organ failure and death. Therapeutic strategies to resuscitate the microcirculatory blood flow and to improve the functional capillar density are therefore essential to surmount the microcirculatory pathology and to avoid tissue hypoxia. Based on reasonable scientific evidence, early fluid resuscitation directed by defined haemodynamic and metabolic goals (EGDT) as well as the application of activated protein C (rhAPC) according to the guidelines could be recommended. Dobutamine is the first choice to improve cardiac output and to overcome myocardial depression in septic shock whereas phosphodiesterase-III-inhibitors and levosimendane are still experimental options. Furthermore selective inhibitors of iNOS, nitroglycerol, as well as vasopressin have to be investigated relating to their specific effects on the microcirculation and their influence on survival in seevere sepsis and septic shock.
ISSN:0720-9355