Microcirculation Taku FURUKAWA 1 , Masamitsu SANUI 1 1Department of Anesthesiology and Critical Care Medicine Jichi Medical University Saitama Medical Center pp.131-140
Published Date 2020/1/1
DOI https://doi.org/10.11477/mf.3102200718
  • Abstract
  • Look Inside
  • Reference

Oxygen diffusion and extraction to peripheral tissues takes place in the microcirculation, consisting of arterioles, venules, and capillaries <100μm in diameter. In critically illnesses including sepsis, disturbance of the microcirculation has been shown to be common and often dissociated from global hemodynamics. Microcirculatory alterations can be associated more directly with tissue hypoperfusion, organ dysfunction, and consequently worse outcomes. Several methods, including handheld microscopes (HVMs), near infrared spectroscopy (NIRS) and skin perfusion, are available to evaluate the microcirculation at the bedside. At the present time, however, these methods are mostly used for research purposes only. Microcirculatory alterations vary depending on the associated pathophysiology. In severe sepsis or septic shock, these alterations are characterized by a decrease in capillary density with increased heterogeneous perfusion. Classic hemodynamic interventions such as fluids, inotropes, vasopressors and red blood cell transfusions, have variable effects on the microcirculation with individual variations. These effects cannot be predicted by global hemodynamics. Vasodilators, anticoagulants, steroids and other interventions have also been investigated, but have not been used clinically. Monitoring and interventions focused on the microcirculation have not yet been shown to impact clinical outcomes, but they may play key roles in the near future.

Copyright © 2020, MEDICAL SCIENCES INTERNATIONAL, LTD. All rights reserved.


電子版ISSN 2186-7852 印刷版ISSN 1883-4833 メディカル・サイエンス・インターナショナル