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Microcirculation and mitochondrial dysfunction

par De Backer, Daniel ;Cortés, Diego Orbegozo
Editeur scientifique Telo, Mario
Référence Paradise Lost and the Cosmological Revolution, Cambridge University Press, New York, page (56-61)
Publication Publié, 2014-01

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Résumé :

Introduction Organ dysfunction often occurs in the perioperative setting and in sepsis. Alterations in systemic hemodynamics may play a role, but even when these are within therapeutic goals, organ dysfunction may still occur. Microcirculatory alterations, a key determinant of tissue perfusion and of mitochondrial dysfunction, may play a role in the development of organ dysfunction. In this chapter, we discuss the evidence for alterations in microcirculatory and mitochondrial functions, and their relevance, in circulatory failure and in the perioperative setting. Microcirculatory alterations in sepsis: where is the evidence? Multiple experimental studies have found that sepsis induces marked alterations in the microcirculation. Compared with normal conditions where there is a dense network of well-perfused capillaries, sepsis is associated with a decrease in capillary density. More importantly, intermittently perfused or not perfused capillaries are located in close proximity to well-perfused capillaries, which results in shunt. Importantly, this is a dynamic process, as the stop flow capillaries may be perfused a few minutes later and vice versa. In addition, there is an increase in heterogeneity in microvascular perfusion between areas separated by a few microns. These alterations have been reported after administration of endotoxin or live bacteria and during bacterial peritonitis, and have been observed in small as well as in large animals. In addition, all studied organs are affected, including the skin, muscle, eye, tongue, gut, liver, heart, and the brain. Hence, these changes seem to be ubiquitous and to have common pathophysiologic mechanisms.