Recruiting the microcirculation in septic shock

Legrand, Matthieu; Backer, Daniel De; Dépret, François; Ait‐Oufella, Hafid

doi:10.1186/s13613-019-0577-9

Cited by 29 publications

(25 citation statements)

References 22 publications

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“…As a novel approach, we implemented continuous beat-to-beat-analysis and visualization of the microcirculation with a handheld video microscope to monitor the sublingual microcirculation under these conditions. Prior works in the setting of septic and cardiogenic shock underlined the fact that, particularly in these life-threatening states with high mortality rates, assessment of the cardiovascular status can be challenging as tracked macrocirculatory parameters may seem stable enshrouding deleterious microcirculatory disorders causative for organ dysfunctions ( Jung et al, 2016a ; Jung, 2019 ; Legrand et al, 2019 ). The evaluation of microcirculation at the bedside has been esteemed highly important ( Kara et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Analysis of Macrocirculation and Microcirculation in Microgravity During Parabolic Flights

et al. 2020

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Background Profound knowledge about cardiovascular physiology in the setting of microgravity can help in the course of preparations for human space missions. So far, influences of microgravity on the cardiovascular system have been demonstrated, particularly pertaining to venous fluid shifts. Yet, little is known about the mechanisms of these adaptations on continuous macrocirculatory level and regarding the microcirculation. Methods Twelve healthy volunteers were subjected to alternating microgravity and hypergravity in the course of parabolic flight maneuvers. Under these conditions, as well as in normal gravity, the sublingual microcirculation was assessed by intravital sidestream dark field microscopy. Furthermore, hemodynamic parameters such as heart rate, blood pressure, and cardiac output were recorded by beat-to-beat analysis. In these settings, data acquisition was performed in seated and in supine postures. Results Systolic [median 116 mmHg (102; 129) interquartile range (IQR) vs. 125 mmHg (109; 136) IQR, p = 0.01] as well as diastolic [median 72 mmHg (61; 79) IQR vs. 80 mmHg (69; 89) IQR, p = 0.003] blood pressure was reduced, and cardiac output [median 6.9 l/min (6.5; 8.8) IQR vs. 6.8 l/min (6.2; 8.5) IQR, p = 0.0002] increased in weightlessness compared to normal gravitation phases in the seated but not in the supine posture. However, microcirculation represented by perfused proportion of vessels and by total vessel density was unaffected in acute weightlessness. Conclusion Profound changes of the macrocirculation were found in seated postures, but not in supine postures. However, microcirculation remained stable in all postures.

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Section: Discussionmentioning

confidence: 99%

Comprehensive Analysis of Macrocirculation and Microcirculation in Microgravity During Parabolic Flights

et al. 2020

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“…More recently, Hernandez et al ( 53 ) failed to demonstrate any beneficial effect of dobutamine neither on the sublingual microcirculation nor on metabolic, hepatosplanchnic or peripheral perfusion parameters. Based on a theoretical benefit of vasodilating drugs ( 54 – 56 ) the use of NO releasing compounds has been investigated. Administration of nitroglycerin increased the perfusion of sublingual microvessels ( 57 ), but, as mentioned previously, continuous infusion over 24 h trended to a worse outcome in a study including 70 patients ( p = 0.08) ( 27 ).…”

Section: Does “Microvascular Resuscitation” Help?mentioning

confidence: 99%

Microcirculation vs. Mitochondria—What to Target?

et al. 2020

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Circulatory shock is associated with marked disturbances of the macro- and microcirculation and flow heterogeneities. Furthermore, a lack of tissue adenosine trisphosphate (ATP) and mitochondrial dysfunction are directly associated with organ failure and poor patient outcome. While it remains unclear if microcirculation-targeted resuscitation strategies can even abolish shock-induced flow heterogeneity, mitochondrial dysfunction and subsequently diminished ATP production could still lead to organ dysfunction and failure even if microcirculatory function is restored or maintained. Preserved mitochondrial function is clearly associated with better patient outcome. This review elucidates the role of the microcirculation and mitochondria during circulatory shock and patient management and will give a viewpoint on the advantages and disadvantages of tailoring resuscitation to microvascular or mitochondrial targets.

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“…After publication of the original article [1], we were notified that an author’s name has been incorrectly spelled. Author’s first name is Hafid and the family name is Ait-Oufella (with a hyphen between Ait and Oufella).…”

Section: Correction To: Ann Intensive Care (2019) 9:102 101186/s136mentioning

confidence: 99%