Clinical manifestations of disordered microcirculatory perfusion in severe sepsis
By Stephen Trzeciak and Emanuel P Rivers
This study examines the potential impact of novel therapies on microcirculatory blood flow in sepsis, focusing on vasodilator agents. It suggests that the microcirculation could be a promising target for new treatments, especially if traditional markers of resuscitation effectiveness fail to normalize despite achieving goals for upstream endpoints.
Clinical studies have shown that vasodilators like prostacyclin, nitroglycerin, and dobutamine can improve microcirculatory blood flow in septic shock patients. However, their clinical impact remains uncertain, and their use has been limited due to side effects such as arterial hypotension.
(The microcirculatory shunting model of sepsis. Severe flow impairment (denoted by X) in weak microcirculatory units causes a shunting of blood to open microcirculatory units. Elevation of serum lactate concentration (from the microcirculatory units with impaired flow) may be simultaneously observed along with venous hyperoxia from the shunted units. Adapted with permission.)
New technologies like OPS imaging allow direct visualization of microcirculatory flow impairments in severe sepsis, and studies using these tools have highlighted the importance of microcirculatory dysfunction as a predictor of mortality. Future research using these technologies will help determine the role of microcirculatory dysfunction in oxygen transport and the effects of novel therapies on microcirculatory blood flow in sepsis.
Read the full study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226160/
(side note)
Can vasodilators like prostacyclin, nitroglycerin, and dobutamine improve microcirculatory?
Yes, vasodilators such as prostacyclin, nitroglycerin, and dobutamine have been shown in clinical studies to potentially improve microcirculatory blood flow in septic shock patients. These vasodilators work through different mechanisms to dilate blood vessels, which can lead to improved perfusion in the microcirculation. Studies have demonstrated that administration of these vasodilators can result in increased microcirculatory blood flow in patients with severe sepsis. However, it’s important to note that the clinical impact of using these vasodilators to improve microcirculatory function is still under investigation, and their use may be limited by potential side effects. Further research is needed to fully understand the effectiveness and safety of using vasodilators to target microcirculatory dysfunction in sepsis.
What is the side effect of prostacyclin, nitroglycerin, and dobutamine?
Vasodilators like prostacyclin, nitroglycerin, and dobutamine can have various side effects:
Prostacyclin (PGI2)
– Prostacyclin can induce or exacerbate arterial hypotension, leading to a drop in blood pressure.
– It may also cause flushing and headache.
– In some cases, prostacyclin can be poorly tolerated by patients due to its hypotensive effects.
Nitroglycerin
– Nitroglycerin is known to cause vasodilation, which can lead to a decrease in blood pressure.
– Common side effects include headache, dizziness, and flushing.
– Nitroglycerin can also cause reflex tachycardia (increased heart rate) as the body attempts to compensate for the drop in blood pressure.
Dobutamine
– Dobutamine is a beta-adrenergic agonist that primarily acts as an inotropic agent, but it also has vasodilatory effects.
– Common side effects include increased heart rate (tachycardia) and palpitations.
– Dobutamine can also cause arrhythmias (irregular heartbeats) and myocardial ischemia in some cases.
It’s important to note that the side effects of these vasodilators can vary depending on factors such as the dosage, route of administration, and individual patient characteristics. Additionally, these medications should be used cautiously and under medical supervision to monitor for adverse reactions.
