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Erschienen in: Critical Care 6/2004

01.12.2004 | Review

Bench-to-bedside review: Sepsis is a disease of the microcirculation

verfasst von: Peter E Spronk, Durk F Zandstra, Can Ince

Erschienen in: Critical Care | Ausgabe 6/2004

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Abstract

Microcirculatory perfusion is disturbed in sepsis. Recent research has shown that maintaining systemic blood pressure is associated with inadequate perfusion of the microcirculation in sepsis. Microcirculatory perfusion is regulated by an intricate interplay of many neuroendocrine and paracrine pathways, which makes blood flow though this microvascular network a heterogeneous process. Owing to an increased microcirculatory resistance, a maldistribution of blood flow occurs with a decreased systemic vascular resistance due to shunting phenomena. Therapy in shock is aimed at the optimization of cardiac function, arterial hemoglobin saturation and tissue perfusion. This will mean the correction of hypovolemia and the restoration of an evenly distributed microcirculatory flow and adequate oxygen transport. A practical clinical score for the definition of shock is proposed and a novel technique for bedside visualization of the capillary network is discussed, including its possible implications for the treatment of septic shock patients with vasodilators to open the microcirculation.
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Literatur
1.
Zurück zum Zitat Carley S, Driscoll P: Trauma education. Resuscitation 2001, 48: 47-56. 10.1016/S0300-9572(00)00317-8CrossRefPubMed Carley S, Driscoll P: Trauma education. Resuscitation 2001, 48: 47-56. 10.1016/S0300-9572(00)00317-8CrossRefPubMed
2.
Zurück zum Zitat Vincent JL: Hemodynamic support in septic shock. Intensive Care Med 2001,27(Suppl 1):S80-S92.CrossRefPubMed Vincent JL: Hemodynamic support in septic shock. Intensive Care Med 2001,27(Suppl 1):S80-S92.CrossRefPubMed
4.
5.
Zurück zum Zitat Harvey W: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus 1628. Harvey W: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus 1628.
6.
7.
Zurück zum Zitat Lehr HA, Bittinger F, Kirkpatrick CJ: Microcirculatory dysfunction in sepsis: a pathogenetic basis for therapy? J Pathol 2000, 190: 373-386. 10.1002/(SICI)1096-9896(200002)190:3<373::AID-PATH593>3.3.CO;2-VCrossRefPubMed Lehr HA, Bittinger F, Kirkpatrick CJ: Microcirculatory dysfunction in sepsis: a pathogenetic basis for therapy? J Pathol 2000, 190: 373-386. 10.1002/(SICI)1096-9896(200002)190:3<373::AID-PATH593>3.3.CO;2-VCrossRefPubMed
8.
Zurück zum Zitat Astiz ME, DeGent GE, Lin RY, Rackow EC: Microvascular function and rheologic changes in hyperdynamic sepsis. Crit Care Med 1995, 23: 265-271. 10.1097/00003246-199502000-00011CrossRefPubMed Astiz ME, DeGent GE, Lin RY, Rackow EC: Microvascular function and rheologic changes in hyperdynamic sepsis. Crit Care Med 1995, 23: 265-271. 10.1097/00003246-199502000-00011CrossRefPubMed
9.
Zurück zum Zitat Linderkamp O, Ruef P, Brenner B, Gulbins E, Lang F: Passive deformability of mature, immature, and active neutrophils in healthy and septicemic neonates. Pediatr Res 1998, 44: 946-950.CrossRefPubMed Linderkamp O, Ruef P, Brenner B, Gulbins E, Lang F: Passive deformability of mature, immature, and active neutrophils in healthy and septicemic neonates. Pediatr Res 1998, 44: 946-950.CrossRefPubMed
10.
Zurück zum Zitat Diaz NL, Finol HJ, Torres SH, Zambrano CI, Adjounian H: Histochemical and ultrastructural study of skeletal muscle in patients with sepsis and multiple organ failure syndrome (MOFS). Histol Histopathol 1998, 13: 121-128.PubMed Diaz NL, Finol HJ, Torres SH, Zambrano CI, Adjounian H: Histochemical and ultrastructural study of skeletal muscle in patients with sepsis and multiple organ failure syndrome (MOFS). Histol Histopathol 1998, 13: 121-128.PubMed
11.
Zurück zum Zitat Avontuur JA, Bruining HA, Ince C: Nitric oxide causes dysfunction of coronary autoregulation in endotoxemic rats. Cardiovasc Res 1997, 35: 368-376. 10.1016/S0008-6363(97)00132-6CrossRefPubMed Avontuur JA, Bruining HA, Ince C: Nitric oxide causes dysfunction of coronary autoregulation in endotoxemic rats. Cardiovasc Res 1997, 35: 368-376. 10.1016/S0008-6363(97)00132-6CrossRefPubMed
12.
Zurück zum Zitat Cronenwett JL, Lindenauer SM: Direct measurement of arteriovenous anastomotic blood flow in the septic canine hindlimb. Surgery 1979, 85: 275-282.PubMed Cronenwett JL, Lindenauer SM: Direct measurement of arteriovenous anastomotic blood flow in the septic canine hindlimb. Surgery 1979, 85: 275-282.PubMed
13.
Zurück zum Zitat Ince C: Microcirculatory weak units – an alternative explanation. Crit Care Med 2000, 28: 3127-3129.CrossRef Ince C: Microcirculatory weak units – an alternative explanation. Crit Care Med 2000, 28: 3127-3129.CrossRef
14.
Zurück zum Zitat Ince C, Sinaasappel M: Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999, 27: 1369-1377. 10.1097/00003246-199907000-00031CrossRefPubMed Ince C, Sinaasappel M: Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999, 27: 1369-1377. 10.1097/00003246-199907000-00031CrossRefPubMed
15.
Zurück zum Zitat Buwalda M, Ince C: Opening the microcirculation: can vasodilators be useful in sepsis? Intensive Care Med 2002, 28: 1208-1217. 10.1007/s00134-002-1407-2CrossRefPubMed Buwalda M, Ince C: Opening the microcirculation: can vasodilators be useful in sepsis? Intensive Care Med 2002, 28: 1208-1217. 10.1007/s00134-002-1407-2CrossRefPubMed
16.
Zurück zum Zitat Lam C, Tyml K, Martin C, Sibbald W: Microvascular perfusion is impaired in a rat model of normotensive sepsis. J Clin Invest 1994, 94: 2077-2083.PubMedCentralCrossRefPubMed Lam C, Tyml K, Martin C, Sibbald W: Microvascular perfusion is impaired in a rat model of normotensive sepsis. J Clin Invest 1994, 94: 2077-2083.PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Sinaasappel M, van Iterson M, Ince C: Microvascular oxygen pressure in the pig intestine during haemorrhagic shock and resuscitation. J Physiol 1999, 514: 245-253. 10.1111/j.1469-7793.1999.245af.xPubMedCentralCrossRefPubMed Sinaasappel M, van Iterson M, Ince C: Microvascular oxygen pressure in the pig intestine during haemorrhagic shock and resuscitation. J Physiol 1999, 514: 245-253. 10.1111/j.1469-7793.1999.245af.xPubMedCentralCrossRefPubMed
18.
Zurück zum Zitat van Iterson M, Sinaasappel M, Burhop K, Trouwborst A, Ince C: Low-volume resuscitation with a hemoglobin-based oxygen carrier after hemorrhage improves gut microvascular oxygenation in swine. J Lab Clin Med 1998, 132: 421-431. 10.1016/S0022-2143(98)90113-5CrossRefPubMed van Iterson M, Sinaasappel M, Burhop K, Trouwborst A, Ince C: Low-volume resuscitation with a hemoglobin-based oxygen carrier after hemorrhage improves gut microvascular oxygenation in swine. J Lab Clin Med 1998, 132: 421-431. 10.1016/S0022-2143(98)90113-5CrossRefPubMed
19.
Zurück zum Zitat Erdmann E: The effect of positive inotropes on the failing human myocardium. Cardiology 1997,88(Suppl 2):7-11.CrossRefPubMed Erdmann E: The effect of positive inotropes on the failing human myocardium. Cardiology 1997,88(Suppl 2):7-11.CrossRefPubMed
20.
Zurück zum Zitat Zhang H, Rogiers P, Smail N, Cabral A, Preiser JC, Peny MO, Vincent JL: Effects of nitric oxide on blood flow distribution and O2 extraction capabilities during endotoxic shock. J Appl Physiol 1997, 83: 1164-1173.PubMed Zhang H, Rogiers P, Smail N, Cabral A, Preiser JC, Peny MO, Vincent JL: Effects of nitric oxide on blood flow distribution and O2 extraction capabilities during endotoxic shock. J Appl Physiol 1997, 83: 1164-1173.PubMed
21.
Zurück zum Zitat Siegemund M, van Bommel J, Ince C: Influence of NO donor SIN-1 on the gut oxygenation in a normodynamic, porcine model of low-dose endotoxaemia. Intensive Care Med 2000, 26: S362. Siegemund M, van Bommel J, Ince C: Influence of NO donor SIN-1 on the gut oxygenation in a normodynamic, porcine model of low-dose endotoxaemia. Intensive Care Med 2000, 26: S362.
22.
Zurück zum Zitat Lush CW, Kvietys PR: Microvascular dysfunction in sepsis. Microcirculation 2000, 7: 83-101. 10.1038/sj.mn.7300096CrossRefPubMed Lush CW, Kvietys PR: Microvascular dysfunction in sepsis. Microcirculation 2000, 7: 83-101. 10.1038/sj.mn.7300096CrossRefPubMed
23.
Zurück zum Zitat Cain SM, Curtis SE: Experimental models of pathologic oxygen supply dependency. Crit Care Med 1991, 19: 603-612.CrossRefPubMed Cain SM, Curtis SE: Experimental models of pathologic oxygen supply dependency. Crit Care Med 1991, 19: 603-612.CrossRefPubMed
24.
Zurück zum Zitat Nelson DP, Samsel RW, Wood LDH, Schumacker PT: Experimental models of pathologic oxygen supply dependency. J Appl Physiol 1988, 64: 2410-2419.PubMed Nelson DP, Samsel RW, Wood LDH, Schumacker PT: Experimental models of pathologic oxygen supply dependency. J Appl Physiol 1988, 64: 2410-2419.PubMed
25.
Zurück zum Zitat Vallet B, Lund N, Curtis SE, Kelly D, Cain SM: Gut and muscle tissue pO 2 in endotoxemic dogs during shock and resuscitation. J Appl Physiol 1994, 76: 793-800.PubMed Vallet B, Lund N, Curtis SE, Kelly D, Cain SM: Gut and muscle tissue pO 2 in endotoxemic dogs during shock and resuscitation. J Appl Physiol 1994, 76: 793-800.PubMed
26.
Zurück zum Zitat Bakker J, Coffernils M, Leon M, Gris P, Vincent JL: Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 1991, 99: 956-962.CrossRefPubMed Bakker J, Coffernils M, Leon M, Gris P, Vincent JL: Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 1991, 99: 956-962.CrossRefPubMed
27.
Zurück zum Zitat De Backer D: Lactic acidosis. Intensive Care Med 2003, 29: 699-702.PubMed De Backer D: Lactic acidosis. Intensive Care Med 2003, 29: 699-702.PubMed
28.
Zurück zum Zitat Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D: Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994, 330: 1717-1722. 10.1056/NEJM199406163302404CrossRefPubMed
29.
Zurück zum Zitat Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601CrossRefPubMed Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R: A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995, 333: 1025-1032. 10.1056/NEJM199510193331601CrossRefPubMed
30.
Zurück zum Zitat Creteur J, De Backer D, Vincent JL: A dobutamine test can disclose hepatosplanchnic hypoperfusion in septic patients. Am J Respir Crit Care Med 1999, 160: 839-845.CrossRefPubMed Creteur J, De Backer D, Vincent JL: A dobutamine test can disclose hepatosplanchnic hypoperfusion in septic patients. Am J Respir Crit Care Med 1999, 160: 839-845.CrossRefPubMed
31.
Zurück zum Zitat Kaplan LJ, McPartland K, Santora TA, Trooskin SZ: Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients. J Trauma 2001, 50: 620-627.CrossRefPubMed Kaplan LJ, McPartland K, Santora TA, Trooskin SZ: Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients. J Trauma 2001, 50: 620-627.CrossRefPubMed
32.
Zurück zum Zitat Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed
33.
Zurück zum Zitat Fiddian-Green RG, Baker S: Predictive value of the stomach wall pH for complications after cardiac operations: comparison with other monitoring. Crit Care Med 1987, 15: 153-156.CrossRefPubMed Fiddian-Green RG, Baker S: Predictive value of the stomach wall pH for complications after cardiac operations: comparison with other monitoring. Crit Care Med 1987, 15: 153-156.CrossRefPubMed
34.
Zurück zum Zitat Lowes BD, Tsvetkova T, Eichhorn EJ, Gilbert EM, Bristow MR: Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. Int J Cardiol 2001, 81: 141-149. 10.1016/S0167-5273(01)00520-4CrossRefPubMed Lowes BD, Tsvetkova T, Eichhorn EJ, Gilbert EM, Bristow MR: Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. Int J Cardiol 2001, 81: 141-149. 10.1016/S0167-5273(01)00520-4CrossRefPubMed
35.
Zurück zum Zitat Vallet B, Ince C: Noninvasive assessment of tissue oxygenation. Semin Respir Crit Care Med 1999, 20: 3-10.CrossRef Vallet B, Ince C: Noninvasive assessment of tissue oxygenation. Semin Respir Crit Care Med 1999, 20: 3-10.CrossRef
36.
Zurück zum Zitat Marik PE: Sublingual capnography: a clinical validation study. Chest 2001, 120: 923-927. 10.1378/chest.120.3.923CrossRefPubMed Marik PE: Sublingual capnography: a clinical validation study. Chest 2001, 120: 923-927. 10.1378/chest.120.3.923CrossRefPubMed
37.
Zurück zum Zitat Marik PE, Bankov A: Sublingual capnometry versus traditional markers of tissue oxygenation in critically ill patients. Crit Care Med 2003, 31: 818-822. 10.1097/01.CCM.0000054862.74829.EACrossRefPubMed Marik PE, Bankov A: Sublingual capnometry versus traditional markers of tissue oxygenation in critically ill patients. Crit Care Med 2003, 31: 818-822. 10.1097/01.CCM.0000054862.74829.EACrossRefPubMed
38.
Zurück zum Zitat Saetzler RK, Jallo J, Lehr HA, Philips CM, Vasthare U, Arfors KE, Tuma RF: Intravital fluorescence microscopy: impact of light-induced phototoxicity on adhesion of fluorescently labeled leukocytes. J Histochem Cytochem 1997, 45: 505-513.CrossRefPubMed Saetzler RK, Jallo J, Lehr HA, Philips CM, Vasthare U, Arfors KE, Tuma RF: Intravital fluorescence microscopy: impact of light-induced phototoxicity on adhesion of fluorescently labeled leukocytes. J Histochem Cytochem 1997, 45: 505-513.CrossRefPubMed
39.
Zurück zum Zitat Steinbauer M, Harris AG, Abels C, Messmer K: Characterization and prevention of phototoxic effects in intravital fluorescence microscopy in the hamster dorsal skinfold model. Langenbecks Arch Surg 2000, 385: 290-298. 10.1007/s004239900108CrossRefPubMed Steinbauer M, Harris AG, Abels C, Messmer K: Characterization and prevention of phototoxic effects in intravital fluorescence microscopy in the hamster dorsal skinfold model. Langenbecks Arch Surg 2000, 385: 290-298. 10.1007/s004239900108CrossRefPubMed
40.
Zurück zum Zitat Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG: Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 1999, 5: 1209-1212. 10.1038/13529CrossRefPubMed Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG: Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 1999, 5: 1209-1212. 10.1038/13529CrossRefPubMed
41.
Zurück zum Zitat Mathura KR, Alic L, Ince C: Initial clinical experience with OPS imaging for observation of the human microcirculation. In Yearbook of Intensive Care and Emergency Medicine (Edited by: Vincent JL). Berlin: Springer Verlag 2001, 233-245. Mathura KR, Alic L, Ince C: Initial clinical experience with OPS imaging for observation of the human microcirculation. In Yearbook of Intensive Care and Emergency Medicine (Edited by: Vincent JL). Berlin: Springer Verlag 2001, 233-245.
42.
Zurück zum Zitat Mathura KR, Vollebregt KC, Boer K, De Graaff JC, Ubbink DT, Ince C: Comparison of OPS imaging and conventional capillary microscopy to study the human microcirculation. J Appl Physiol 2001, 91: 74-78.PubMed Mathura KR, Vollebregt KC, Boer K, De Graaff JC, Ubbink DT, Ince C: Comparison of OPS imaging and conventional capillary microscopy to study the human microcirculation. J Appl Physiol 2001, 91: 74-78.PubMed
43.
Zurück zum Zitat Liu L, Zhao SP: The changes of circulating tumor necrosis factor levels in patients with congestive heart failure influenced by therapy. Int J Cardiol 1999, 69: 77-82. 10.1016/S0167-5273(99)00008-XCrossRefPubMed Liu L, Zhao SP: The changes of circulating tumor necrosis factor levels in patients with congestive heart failure influenced by therapy. Int J Cardiol 1999, 69: 77-82. 10.1016/S0167-5273(99)00008-XCrossRefPubMed
44.
Zurück zum Zitat Robin ED: Of men and mitochondria: coping with hypoxic dysoxia. The 1980 J Burns Amberson Lecture. Am Rev Respir Dis 1980, 122: 517-531.PubMed Robin ED: Of men and mitochondria: coping with hypoxic dysoxia. The 1980 J Burns Amberson Lecture. Am Rev Respir Dis 1980, 122: 517-531.PubMed
45.
Zurück zum Zitat De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL: Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002, 166: 98-104. 10.1164/rccm.200109-016OCCrossRefPubMed De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL: Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002, 166: 98-104. 10.1164/rccm.200109-016OCCrossRefPubMed
46.
Zurück zum Zitat Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF: Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 2002, 360: 1395-1396. 10.1016/S0140-6736(02)11393-6CrossRefPubMed Spronk PE, Ince C, Gardien MJ, Mathura KR, Oudemans-van Straaten HM, Zandstra DF: Nitroglycerin in septic shock after intravascular volume resuscitation. Lancet 2002, 360: 1395-1396. 10.1016/S0140-6736(02)11393-6CrossRefPubMed
47.
Zurück zum Zitat Baskurt OK, Temiz A, Meiselman HJ: Red blood cell aggregation in experimental sepsis. J Lab Clin Med 1997, 130: 183-190. 10.1016/S0022-2143(97)90094-9CrossRefPubMed Baskurt OK, Temiz A, Meiselman HJ: Red blood cell aggregation in experimental sepsis. J Lab Clin Med 1997, 130: 183-190. 10.1016/S0022-2143(97)90094-9CrossRefPubMed
48.
Zurück zum Zitat Siegemund M, Racovitza I, Ince C: The rationale for vasodilator therapy in sepsis. In Yearbook of Intensive Care and Emergency Medicine (Edited by: Vincent JL). Berlin: Springer Verlag 2002, 221-231. Siegemund M, Racovitza I, Ince C: The rationale for vasodilator therapy in sepsis. In Yearbook of Intensive Care and Emergency Medicine (Edited by: Vincent JL). Berlin: Springer Verlag 2002, 221-231.
49.
Zurück zum Zitat Piagnerelli M, Boudjeltia KZ, Vanhaeverbeek M, Vincent JL: Red blood cell rheology in sepsis. Intensive Care Med 2003, 29: 1052-1061. 10.1007/s00134-003-1783-2CrossRefPubMed Piagnerelli M, Boudjeltia KZ, Vanhaeverbeek M, Vincent JL: Red blood cell rheology in sepsis. Intensive Care Med 2003, 29: 1052-1061. 10.1007/s00134-003-1783-2CrossRefPubMed
50.
Zurück zum Zitat Bateman RM, Sharpe MD, Ellis CG: Bench-to-bedside review: microvascular dysfunction in sepsis – hemodynamics, oxygen transport, and nitric oxide. Crit Care 2003, 7: 359-373. 10.1186/cc2353PubMedCentralCrossRefPubMed Bateman RM, Sharpe MD, Ellis CG: Bench-to-bedside review: microvascular dysfunction in sepsis – hemodynamics, oxygen transport, and nitric oxide. Crit Care 2003, 7: 359-373. 10.1186/cc2353PubMedCentralCrossRefPubMed
51.
Zurück zum Zitat Zhao KS, Junker D, Delano FA, Zweifach BW: Microvascular adjustments during irreversible hemorrhagic shock in rat skeletal muscle. Microvasc Res 1985, 30: 143-153. 10.1016/0026-2862(85)90046-9CrossRefPubMed Zhao KS, Junker D, Delano FA, Zweifach BW: Microvascular adjustments during irreversible hemorrhagic shock in rat skeletal muscle. Microvasc Res 1985, 30: 143-153. 10.1016/0026-2862(85)90046-9CrossRefPubMed
52.
Zurück zum Zitat Bihari D, Smithies M, Gimson A, Tinker J: The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 1987, 317: 397-403.CrossRefPubMed Bihari D, Smithies M, Gimson A, Tinker J: The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 1987, 317: 397-403.CrossRefPubMed
53.
Zurück zum Zitat Dubois MJ, De Backer D, Creteur J, Anane S, Vincent JL: Effect of vasopressin on sublingual microcirculation in a patient with distributive shock. Intensive Care Med 2003, 29: 1020-1023.PubMed Dubois MJ, De Backer D, Creteur J, Anane S, Vincent JL: Effect of vasopressin on sublingual microcirculation in a patient with distributive shock. Intensive Care Med 2003, 29: 1020-1023.PubMed
54.
Zurück zum Zitat Vallance P: Exploring vascular nitric oxide in health and disease. The Goulstonian Lecture 1996. J R Coll Physicians Lond 1997, 31: 321-327.PubMed Vallance P: Exploring vascular nitric oxide in health and disease. The Goulstonian Lecture 1996. J R Coll Physicians Lond 1997, 31: 321-327.PubMed
55.
Zurück zum Zitat Wang P, Ba ZF, Chaudry IH: Endothelium-dependent relaxation is depressed at the macro- and microcirculatory levels during sepsis. Am J Physiol 1995, 269: R988-R994.PubMed Wang P, Ba ZF, Chaudry IH: Endothelium-dependent relaxation is depressed at the macro- and microcirculatory levels during sepsis. Am J Physiol 1995, 269: R988-R994.PubMed
56.
Zurück zum Zitat Reade MC, Young D, Boyd CAR: Nitric oxide synthases are decreased in mononuclear cells from sepsis patients. Crit Care Med 2003, 31: A52.CrossRef Reade MC, Young D, Boyd CAR: Nitric oxide synthases are decreased in mononuclear cells from sepsis patients. Crit Care Med 2003, 31: A52.CrossRef
57.
Zurück zum Zitat Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, Silverman MS, Takala J, Donaldson J, Arneson C, Grove G, Grossman S, Grover R: Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004, 32: 21-30. 10.1097/01.CCM.0000105581.01815.C6CrossRefPubMed Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, Silverman MS, Takala J, Donaldson J, Arneson C, Grove G, Grossman S, Grover R: Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 2004, 32: 21-30. 10.1097/01.CCM.0000105581.01815.C6CrossRefPubMed
58.
Zurück zum Zitat Grover R, Lopez A, Lorente JA, Grossman S: Multicenter, randomized, placebo controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 1999,27(Suppl):A33. 10.1097/00003246-199901001-00021CrossRef Grover R, Lopez A, Lorente JA, Grossman S: Multicenter, randomized, placebo controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 1999,27(Suppl):A33. 10.1097/00003246-199901001-00021CrossRef
59.
Zurück zum Zitat Vincent JL, Zhang H, Szabo C, Preiser JC: Effects of nitric oxide in septic shock. Am J Respir Crit Care Med 2000, 161: 1781-1785.CrossRefPubMed Vincent JL, Zhang H, Szabo C, Preiser JC: Effects of nitric oxide in septic shock. Am J Respir Crit Care Med 2000, 161: 1781-1785.CrossRefPubMed
60.
Zurück zum Zitat Pittner A, Nalos M, Asfar P, Yang Y, Ince C, Georgieff M, Bruckner UB, Radermacher P, Froba G: Mechanisms of inducible nitric oxide synthase (iNOS) inhibition-related improvement of gut mucosal acidosis during hyperdynamic porcine endo-toxemia. Intensive Care Med 2003, 29: 312-316.PubMed Pittner A, Nalos M, Asfar P, Yang Y, Ince C, Georgieff M, Bruckner UB, Radermacher P, Froba G: Mechanisms of inducible nitric oxide synthase (iNOS) inhibition-related improvement of gut mucosal acidosis during hyperdynamic porcine endo-toxemia. Intensive Care Med 2003, 29: 312-316.PubMed
61.
Zurück zum Zitat Li H, Förstermann U: Nitric oxide in the pathogenesis of vascular disease. J Pathol 2000, 190: 244-254. 10.1002/(SICI)1096-9896(200002)190:3<244::AID-PATH575>3.0.CO;2-8CrossRefPubMed Li H, Förstermann U: Nitric oxide in the pathogenesis of vascular disease. J Pathol 2000, 190: 244-254. 10.1002/(SICI)1096-9896(200002)190:3<244::AID-PATH575>3.0.CO;2-8CrossRefPubMed
62.
Zurück zum Zitat Siostrzonek P, Koreny M, Delle-Karth G, Haumer M, Koller-Strametz J, Heinz G: Milrinone therapy in catecholamine-dependent critically ill patients with heart failure. Acta Anaesthesiol Scand 2000, 44: 403-409. 10.1034/j.1399-6576.2000.440408.xCrossRefPubMed Siostrzonek P, Koreny M, Delle-Karth G, Haumer M, Koller-Strametz J, Heinz G: Milrinone therapy in catecholamine-dependent critically ill patients with heart failure. Acta Anaesthesiol Scand 2000, 44: 403-409. 10.1034/j.1399-6576.2000.440408.xCrossRefPubMed
63.
Zurück zum Zitat Tuchschmidt J, Fried J, Astiz M, Rackow E: Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 1992, 102: 216-220.CrossRefPubMed Tuchschmidt J, Fried J, Astiz M, Rackow E: Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 1992, 102: 216-220.CrossRefPubMed
64.
Zurück zum Zitat Milani RV, Mehra MR, Endres S, Eigler A, Cooper ES, Lavie CJ Jr, Ventura HO: The clinical relevance of circulating tumor necrosis factor-alpha in acute decompensated chronic heart failure without cachexia. Chest 1996, 110: 992-995.CrossRefPubMed Milani RV, Mehra MR, Endres S, Eigler A, Cooper ES, Lavie CJ Jr, Ventura HO: The clinical relevance of circulating tumor necrosis factor-alpha in acute decompensated chronic heart failure without cachexia. Chest 1996, 110: 992-995.CrossRefPubMed
65.
Zurück zum Zitat Hayes MA, Yau EH, Timmins AC, Hinds CJ, Watson D: Response of critically ill patients to treatment aimed at achieving supra-normal oxygen delivery and consumption. Relationship to outcome. Chest 1993, 103: 886-895.CrossRefPubMed Hayes MA, Yau EH, Timmins AC, Hinds CJ, Watson D: Response of critically ill patients to treatment aimed at achieving supra-normal oxygen delivery and consumption. Relationship to outcome. Chest 1993, 103: 886-895.CrossRefPubMed
66.
Zurück zum Zitat Radermacher P, Buhl R, Santak B, Klein M, Kniemeyer HW, Becker H, Tarnow J: The effects of prostacyclin on gastric intramucosal pH in patients with septic shock. Intensive Care Med 1995, 21: 414-421.CrossRefPubMed Radermacher P, Buhl R, Santak B, Klein M, Kniemeyer HW, Becker H, Tarnow J: The effects of prostacyclin on gastric intramucosal pH in patients with septic shock. Intensive Care Med 1995, 21: 414-421.CrossRefPubMed
67.
Zurück zum Zitat Cerra FB, Hassett J, Siegel JH: Vasodilator therapy in clinical sepsis with low output syndrome. J Surg Res 1978, 25: 180-183. 10.1016/0022-4804(78)90074-4CrossRefPubMed Cerra FB, Hassett J, Siegel JH: Vasodilator therapy in clinical sepsis with low output syndrome. J Surg Res 1978, 25: 180-183. 10.1016/0022-4804(78)90074-4CrossRefPubMed
68.
Zurück zum Zitat Groeneveld AB, Hartemink KJ, de Groot MC, Visser J, Thijs LG: Circulating endothelin and nitrate-nitrite relate to hemodynamic and metabolic variables in human septic shock. Shock 1999, 11: 160-166.CrossRefPubMed Groeneveld AB, Hartemink KJ, de Groot MC, Visser J, Thijs LG: Circulating endothelin and nitrate-nitrite relate to hemodynamic and metabolic variables in human septic shock. Shock 1999, 11: 160-166.CrossRefPubMed
69.
Zurück zum Zitat Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M: Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002, 360: 219-223. 10.1016/S0140-6736(02)09459-XCrossRefPubMed Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M: Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002, 360: 219-223. 10.1016/S0140-6736(02)09459-XCrossRefPubMed
Metadaten
Titel
Bench-to-bedside review: Sepsis is a disease of the microcirculation
verfasst von
Peter E Spronk
Durk F Zandstra
Can Ince
Publikationsdatum
01.12.2004
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 6/2004
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc2894

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