Pubblicazioni

Autori:

De Backer, Daniel; Donadello, Katia; Taccone, Fabio Silvio; Ospina Tascon, Gustavo; Salgado, Diamantino; Vincent, Jean Louis

Titolo:

Microcirculatory alterations: potential mechanisms and implications for therapy

Anno:

2011

Tipologia prodotto:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Lingua:

Inglese

Referee:

No

Nome rivista:

ANNALS OF INTENSIVE CARE

ISSN Rivista:

2110-5820

N° Volume:

1

Numero o Fascicolo:

1

Intervallo pagine:

27-27

Parole chiave:

microcirculation, sepsis, oxygen delivery

Breve descrizione dei contenuti:

Multiple experimental and human trials have shown that microcirculatory alterations are frequent in sepsis. In this review, we discuss the characteristics of these alterations, the various mechanisms potentially involved, and the implications for therapy. Sepsis-induced microvascular alterations are characterized by a decrease in capillary density with an increased number of stopped-flow and intermittent-flow capillaries, in close vicinity to well-perfused capillaries. Accordingly, the surface available for exchange is decreased but also is highly heterogeneous. Multiple mechanisms may contribute to these alterations, including endothelial dysfunction, impaired inter-cell communication, altered glycocalyx, adhesion and rolling of white blood cells and platelets, and altered red blood cell deformability. Given the heterogeneous nature of these alterations and the mechanisms potentially involved, classical hemodynamic interventions, such as fluids, red blood cell transfusions, vasopressors, and inotropic agents, have only a limited impact, and the microcirculatory changes often persist after resuscitation. Nevertheless, fluids seem to improve the microcirculation in the early phase of sepsis and dobutamine also can improve the microcirculation, although the magnitude of this effect varies considerably among patients. Finally, maintaining a sufficient perfusion pressure seems to positively influence the microcirculation; however, which mean arterial pressure levels should be targeted remains controversial. Some trials using vasodilating agents, especially nitroglycerin, showed promising initial results but they were challenged in other trials, so it is difficult to recommend the use of these agents in current practice. Other agents can markedly improve the microcirculation, including activated protein C and antithrombin, vitamin C, or steroids. In conclusion, microcirculatory alterations may play an important role in the development of sepsis-related organ dysfunction. At this stage, therapies to target microcirculation specifically are still being investigated.

Id prodotto:

97960

Handle IRIS:

11562/964098

ultima modifica:

11 novembre 2022

Citazione bibliografica:

De Backer, Daniel; Donadello, Katia; Taccone, Fabio Silvio; Ospina Tascon, Gustavo; Salgado, Diamantino; Vincent, Jean Louis, Microcirculatory alterations: potential mechanisms and implications for therapy «ANNALS OF INTENSIVE CARE» , vol. 1 , n. 1 , 2011 , pp. 27-27

Consulta la scheda completa presente nel repository istituzionale della Ricerca di Ateneo