par De Backer, Daniel 
;Verdant, Colin;Chierego, Marialuisa
Référence Réanimation, 13, 2, page (120-125)
Publication Publié, 2004-03
;Verdant, Colin;Chierego, MarialuisaRéférence Réanimation, 13, 2, page (120-125)
Publication Publié, 2004-03
Article révisé par les pairs
| Résumé : | Numerous experimental studies have demonstrated that microvascular blood flow is altered in models of endotoxic shock or peritonitis. These alterations can be observed in various organs, including the skin, muscles, gut muscularis, gut mucosa, liver and kidney. These alterations are characterized by absent or intermittently perfused capillaries and heterogeneity in blood flow. The study of the microcirculation in humans has long been difficult but the recent development of the orthogonal polarization spectral (OPS) imaging techniques allows the direct visualization of the human microcirculation. Using OPS techniques we demonstrated that the sublingual microcirculation of patients with severe sepsis and septic shock is markedly altered and that these alterations are related with outcome. These alterations are not influenced by arterial pressure or vasopressor agents. Performing sequential evaluation of the sublingual microcirculation in patients with septic shock, we observed that microcirculatory alterations rapidly improved in patients surviving the sepsis episode while it remained unaltered in patients dying during their septic episode, whether shock has resolved or not, suggesting that microcirculatory alterations are involved in the pathophysiology of multiple organ failure. Interestingly, these alterations can be reversed by the topical application of acetylcholine or even the systemic administration of nitrates. Accordingly, microcirculatory alterations are frequently observed in septic patients and can have important pathophysiological implications. © 2003 Socié té de réanimation de langue française. Publié par Elsevier SAS. Tous droits réservés. |
