Sepsis and the microcirculation: the impact on outcomes
1Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Current Opinion in Anaesthesiology
|January 26, 2022
Summary
Sepsis can cause persistent tissue hypoxia despite adequate blood flow. New bedside tools monitoring microcirculation show promise for improving patient outcomes in septic shock.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Microcirculation Research
Background:
- Traditional sepsis management focuses on macrocirculatory parameters like mean arterial pressure.
- Evolving sepsis definitions highlight host-response dysregulation and persistent tissue hypoxia.
- Advances in bedside hemodynamic monitoring are driving renewed interest in microcirculation.
Purpose of the Study:
- To review current understanding of sepsis-induced hypoperfusion.
- To highlight recent advances in microcirculation monitoring.
- To explore the impact of biomarkers and therapeutic targets on future research.
Main Methods:
- Review of current literature on sepsis, microcirculation, and hemodynamic monitoring.
- Discussion of emerging bedside monitoring techniques (e.g., video microscopy).
- Analysis of prognostic value of microcirculatory assessments and biomarkers.
Main Results:
- Conventional monitoring inadequately assesses microcirculation and its treatment response.
- Lactate and venous oxygen saturation guide current biomarker-based management.
- Sublingual microcirculatory assessment shows prognostic value, though bedside tools require further validation.
Conclusions:
- Sepsis significantly alters microcirculation, leading to tissue hypoxia and organ dysfunction.
- Bedside microcirculation monitoring tools show potential for guiding resuscitation.
- Further research is needed to validate these tools for clinical application in septic shock.
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