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Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

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Microcirculatory alterations: potential mechanisms and implications for therapy.

Daniel De Backer¹, Katia Donadello, Fabio Silvio Taccone

¹Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium. ddebacke@ulb.ac.be.

Annals of Intensive Care

|September 13, 2011

Summary

Sepsis frequently causes microcirculatory alterations, impacting organ function. While some therapies show limited effects, others like vitamin C and steroids may improve microcirculation, though targeted treatments are still under investigation.

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Area of Science:

Critical Care Medicine
Physiology
Pathophysiology

Background:

Microcirculatory alterations are common in sepsis.
These changes affect capillary density and blood flow, leading to heterogeneous perfusion.
Mechanisms include endothelial dysfunction, altered cell interactions, and impaired red blood cell deformability.

Purpose of the Study:

To review the characteristics of sepsis-induced microcirculatory alterations.
To discuss the underlying mechanisms contributing to these changes.
To evaluate the implications for therapeutic interventions.

Main Methods:

Review of experimental and human trials on sepsis and microcirculation.
Analysis of mechanisms involved in sepsis-related microvascular dysfunction.
Assessment of the impact of various therapeutic strategies on microcirculation.

Main Results:

Sepsis causes decreased capillary density and heterogeneous blood flow.
Endothelial dysfunction, altered cell adhesion, and RBC deformability are key mechanisms.
Standard hemodynamic interventions have limited and variable effects on microcirculation.
Fluids in early sepsis, dobutamine, and certain agents like vitamin C and steroids show potential benefits.

Conclusions:

Microcirculatory alterations are crucial in sepsis-related organ dysfunction.
Current therapies have limited impact, highlighting the need for targeted approaches.
Further research is needed to develop effective microcirculation-specific therapies for sepsis.