Abstract
Sepsis causes increased capillary stopped-flow, loss of capillary density, maldistribution of blood flow and increased oxygen extraction from 'normal' capillaries [1] in skeletal muscle. Since nitric oxide overproduction has been associated with refractory hypotension, capillary stopped-flow and decreased RBC deformability [2], we hypothesized that NO inhibition would prevent microvascular dysfunction. In a rat cecal ligation and perforation sepsis model, plasma NOx- level (NO chemiluminescence) was maintained at baseline by NO inhibition (L-NIL) and skeletal muscle capillary geometry, hemodynamics and RBC O2 saturation (SO2) were quantified (spectrophotometric functional imaging). O2 flux, amount of O2 leaving the capillary per unit surface area, was calculated from capillary dimensions and O2 flow rates. Sepsis increased plasma NOx- (145%), capillary stopped-flow (140%) and O2 flux (70%) and decreased MAP (30%) and RBC supply rate (SR) (25%) (P < 0.05). NO inhibition maintained RBC SR and partially maintained MAP (90% of base-line), but had no effect on capillary stopped-flow or O2 flux. We conclude that NO-independent capillary ischemia caused functional capillaries to off-load greater amounts of O2 to supply larger tissue volumes. Capillary SO2 < 8% indicated microvascular dysregulation and inefficient matching of local O2 delivery to local O2 demand. Improving capillary flow may benefit the septic patient.
Highlights
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis
A recent study showed that vascular endothelial damage was the primary cause of multiple organ failure (MOF) in patients with thrombopenia and that humoral mediators played a major role in the development of this process [1]
We aimed to evaluate the relation between the platelet counts (PC), the C-reactive protein and plasma fibrinolytic capacity in intensive care unit (ICU) patients
Summary
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis. The aim of the study was to evaluate the effects of PEEP on intrathoracic blood volumes and cardiac function measured by the COLD system in ARDS patients. The objective was to identify risk factors and outcome of pregnant women who required intensive care This pilot study aims to find stress (S) and other personality traits (physical symptoms [PS], anger [A]) among the ICU staff, and any existing correlation between them and length of working time (LWT) in the ICU and with educational level (EDL). The role of Drotrecogin alfa (activated) (recombinant human activated protein C [rhAPC]) in modulating microvascular coagulation through the inhibition of thrombin generation has been well studied in experimental and clinical settings of severe sepsis, little is known about its direct anti-inflammatory effects on vascular endothelial cells. The aim is to determine whether an effective lifestyle adaptation program post CABG could enhance the quality of life of the CABG patient
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