Microcirculatory function in sepsis

Blood vessels < 100 µm in diameter constitute the microcirculation. Mechanisms contributing to its dysfunction include enhanced release of vasoactive substances, increased adhesiveness and permeability of the endothelium, and microvascular occlusion by activated coagulation and leukocytes.

So far, direct monitoring of microcirculation is not routinely applied in clinical practice, and no drug specifically targeting microcirculation is available. Hemodynamic therapy is guided by macrocirculatory indices and aims to restore effective tissue perfusion by optimizing vascular filling and global hemodynamics. Impaired microcirculation during systemic inflammation plays an important role in the development of septic organ dysfunction.

To gain more insight into pathophysiological events at the level of the microcirculation, we monitor its function using combined laser Doppler flowmetry and white light spectroscopy. We study the potential of microcirculatory monitoring to guide macrohemodynamic therapy and to predict therapeutic success.

Publications

Sturm T, Leiblein J, Clauß C, Erles E, Thiel M.
Bedside determination of microcirculatory oxygen delivery and uptake: a prospective observational clinical study for proof of principle. Sci Rep. 2021; Dec 31; 11(1):24516.
Abstract on PubMed.

Sturm T, Leiblein J, Schneider-Lindner V, Kirschning T, Thiel M. 2016. Association of Microcirculation, Macrocirculation, and Severity of Illness in Septic Shock: A Prospective Observational Study to Identify Microcirculatory Targets Potentially Suitable for Guidance of Hemodynamic Therapy. J Intensive Care Med. pii: 0885066616671689.
Abstract on PubMed