ABSTRACT
Largely ignored throughout the history of clinical medicine, the microcirculation
has recently been recognized at the bedside as the center of several pathophysiological
processes. Normal microcirculatory function is critical for adequate tissue oxygenation
and organ function, but it has a poorly understood and highly heterogeneous structure
that is related to the diversity of functions that it accomplishes. The most important
function of the microcirculation is the regulation and distribution of oxygen carrying
red blood cells within the different organs. The determinants of oxygen delivery,
blood flow regulation, tissue oxygen tension, and mitochondrial well-being are not
fully understood; however, it is clear that insight into the function of the microcirculation
is key in this respect. In fact, it is clear that the origin of circulatory failure
in critical illness unresponsive to therapy is not represented in systemic hemodynamic
variables but rather in the dysfunction of the microcirculation. The introduction
of bedside techniques into clinical practice that allow the evaluation of the microcirculation
has opened up a new field of functional hemodynamic monitoring, identified the microcirculatory
failure as the most sensitive indicator of circulatory failure associated with adverse
outcome, and has provided the promise of identifying new therapeutic targets. Clinical
research has identified various conventional and new therapeutic approaches that are
successful in modifying the microcirculation. Current research must determine whether
some of these approaches are successful in improving the outcome of critically ill
patients by recruiting the microcirculation.
KEYWORDS
Microcirculation - sepsis - shock - hypoxia - norepinephrine - fluids - nitroglycerin
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Can IncePh.D.
Department of Intensive Care, Erasmus Medical Center, University Medical Center
‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
Email: c.ince@erasmusmc.nl
