Microvascular dysfunction in septic and dengue shock: Pathophysiology and implications for clinical management

Area of Science:

• Physiology
• Pathophysiology
• Vascular Biology

Background:

• The microcirculation, including arterioles, capillaries, and venules, is vital for tissue perfusion.
• Microvascular homeostasis maintains tissue perfusion through a balance of vasoconstriction, vasodilation, and endothelial permeability.
• Severe infections trigger systemic inflammation, leading to microcirculatory dysregulation, impaired perfusion, and potential end-organ failure.

Purpose of the Study:

• To compare and contrast the pathophysiology of microcirculatory dysfunction in septic shock and dengue shock.
• To analyze the distinct mechanisms of microvascular impairment in these two conditions.
• To examine the effects of fluid administration on microvascular function during resuscitation in both septic and dengue shock.

Main Methods:

• This review synthesizes findings from in vitro and in vivo studies.
• It compares and contrasts the pathophysiological mechanisms of microcirculatory dysfunction.
• The review examines the impact of fluid resuscitation strategies in septic and dengue shock.

Main Results:

• Common features of microvascular dysfunction in septic and dengue shock include endothelial activation, glycocalyx degradation, and plasma leakage.
• Both conditions exhibit impaired microvascular tone due to reduced nitric oxide bioavailability.
• However, the nature and extent of microvascular dysfunction and the response to fluid resuscitation differ significantly between septic and dengue shock.

Conclusions:

• Microcirculatory dysfunction is a critical factor in the pathogenesis of septic and dengue shock.
• Understanding the distinct pathophysiological pathways is essential for targeted resuscitation strategies.
• Fluid administration requires careful consideration, as responses vary between septic and dengue shock.