Opening the microcirculation: can vasodilators be useful in sepsis?

Abstract

Prostacyclin and nitric oxide donors are the best studied vasodilating agents in experimental sepsis and have shown improved tissue perfusion and oxygen extraction. In several clinical studies prostacyclin has also been shown to have such beneficial effects. Recent studies using orthogonal polarization spectral imaging have shown microcirculatory recruitment by nitric oxide donors in hemodynamically resuscitated septic patients. Whether such therapeutic modalities aimed at recruitment of the microcirculation improve outcome, however, still has to be determined.

Higher Urine Nitric Oxide Is Associated with Improved Outcomes in Patients with Acute Lung Injury

“…The results in patients with sepsis provided further validation for this study. NO has a well described role in sepsis (33,34,46). We anticipated and found higher urine NO/Cr levels in patients with sepsis.…”

Endothelial Dysfunction Is a Potential Contributor to Multiple Organ Failure and Mortality in Aged Mice Subjected to Septic Shock: Preclinical Studies in a Murine Model of Cecal Ligation and Puncture

“…Endothelial dysfunction promotes neutrophil adhesion and infiltration into tissues, which is a key contributor to MODS [21][22][23][24][25][26][27]. In addition, endothelial dysfunction in sepsis leads to perfusion/oxygenation mismatch and coagulation abnormalities, culminating in mortality in sepsis [8,20,21].…”

Shock séptico en pediatría I: Enfoque actual en el diagnóstico y tratamiento

“…En la actualidad podemos agrupar en tres los mecanismos que ocasionan hipoxia celular: a) falla macrocirculatoria: Se evalúa en la práctica clínica mediante marcadores indirectos del flujo sanguíneo como son presión arterial media (PAM), gasto cardíaco (GC) y saturación venosa central de oxígeno (SvcO 2 ); b) falla microcirculatoria: se manifiesta por una distribución anómala de flujo, con exclusión de arteriolas y capilares (shunt) 51 . Se puede presentar en forma independiente del estado macrocirculatorio, siendo descrita frecuentemente como causa de hipoxia celular a pesar de la normalización de los parámetros hemodinámicos 52 .…”