The Heterogeneity of the Microcirculation in Critical Illness

• Published in: Clinics in chest medicine Vol. 29; no. 4; pp. 643 - 654
• Main Authors: Klijn, Eva, MD, Den Uil, C.A., MD, Bakker, Jan, MD, PhD, Ince, Can, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2008
• Subjects: Brain - blood supply; Conjunctiva - blood supply; Critical Illness; Eye - blood supply; Hemodynamics - physiology; Humans; Intestines - blood supply; Microcirculation; Microcirculation - physiology; Mouth Floor - blood supply; Multi organ failure; Multiple Organ Failure - physiopathology; Orthogonal polarization spectral imaging; Prognosis; Pulmonary/Respiratory; Regional Blood Flow - physiology; Resuscitation; Sepsis; Sepsis - physiopathology; Shock; Shock, Septic - physiopathology; Sidestream dark field imaging; Skin - blood supply; Shock; Critical illness; Microcirculation; Sidestream dark field imaging; Multi organ failure; Orthogonal polarization spectral imaging; Sepsis
• ISSN: 0272-5231; 1557-8216
• DOI: 10.1016/j.ccm.2008.06.008

Microcirculation, a complex and specialized facet of organ architecture, has characteristics that vary according to the function of the tissue it supplies. Bedside technology that can directly observe microcirculation in patients, such as orthogonal polarization spectral imaging and sidestream dark field imaging, has opened the way to investigating this network and its components, especially in critical illness and surgery. These investigations have underscored the central role of microcirculation in perioperative disease states. They have also highlighted variations in the nature of microcirculation, both among organ systems and within specific organs. Supported by experimental studies, current investigations are better defining the nature of microcirculatory alterations in critical illness and how these alterations respond to therapy. This review focuses on studies conducted to date on the microcirculatory beds of critically ill patients. The functional anatomy of microcirculation networks and the role of these networks in the pathogenesis of critical illness are discussed. The morphology of microvascular beds that have been visualized during surgery and intensive care at the bedside are also described, including those of the brain, sublingual region, skin, intestine, and eyes.