Endothelial and Microcirculatory Function and Dysfunction in Sepsis

Abstract

The microcirculation is a series of arterioles, capillaries, and venules that performs essential functions of oxygen and nutrient delivery, customized to the unique physiologic needs of the supplied organ. The homeostatic microcirculatory response to infection can become harmful if overactive and/or dysregulated. Pathologic microcirculatory dysfunction can be directly visualized by intravital microscopy or indirectly measured via detection of circulating biomarkers. Although several treatments have been shown to protect the microcirculation during sepsis, they have not improved patient outcomes when applied indiscriminately. Future outcomes-oriented studies are needed to test sepsis therapeutics when personalized to a patient's microcirculatory dysfunction.

Keywords: Glycocalyx; Glycosaminoglycans; Heparan sulfate; Intravital microscopy; Microcirculation; Sepsis.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Homeostatic vs. pathologic (septic) pulmonary, renal microvascular responses to infection

Figure 2

Semiquantitative assessment of sublingual microvascular flow. Intravital microscopy can access the sublingual miscrovasculature (OPS image, middle). Semiquanitative measurements of flow in each quadrant of image yields an average mean flow (MFI); at least 5 images should be measured. Adapted from Klijn E, Den Uil CA, Bakker J, Ince C. The heterogeneity of the microcirculation in critical illness. Clinics in Chest Medicine. 2008;29(4):643–654; with permission.

Figure 3

The Endothelial Glycocalyx