Microcirculatory dysfunction in sepsis

In the last few years, an important body of knowledge has been developed showing the pathophysiological relevance of the sublingual microcirculation in the development of multiorgan failure associated with sepsis. In addition to the compelling experimental evidence, the development of new videomicroscopic techniques allows now the evaluation of the microcirculation in critically ill patients. Consequently, the sublingual microcirculation can be easily monitored at bedside. Therefore, studies performed in the sublingual area show that severe microcirculatory sublingual alterations are present in septic patients. Moreover, these alterations have an important prognostic value. Finally, sublingual microvascular alterations can be modified by therapeutic interventions. In this article, we review relevant information related to the pathophysiology of the microcirculation in health and disease with special reference to the behavior of the mesenteric territory during shock states and the alterations of sublingual microcirculation in septic patients as well as their responses to different therapeutic approaches.