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The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients
PURPOSE: The clinical use of vasoactive drugs is not only intended to improve systemic hemodynamic variables, but ultimately to attenuate derangements in organ perfusion and oxygenation during shock. This review aims (1) to discuss basic physiology with respect to manipulating vascular tone and its...
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Formato: | Texto |
Lenguaje: | English |
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Springer-Verlag
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981743/ https://www.ncbi.nlm.nih.gov/pubmed/20811874 http://dx.doi.org/10.1007/s00134-010-1970-x |
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author | Boerma, E. Christiaan Ince, Can |
author_facet | Boerma, E. Christiaan Ince, Can |
author_sort | Boerma, E. Christiaan |
collection | PubMed |
description | PURPOSE: The clinical use of vasoactive drugs is not only intended to improve systemic hemodynamic variables, but ultimately to attenuate derangements in organ perfusion and oxygenation during shock. This review aims (1) to discuss basic physiology with respect to manipulating vascular tone and its effect on the microcirculation, and (2) to provide an overview of available clinical data on the relation between vasoactive drugs and organ perfusion, with specific attention paid to recent developments that have enabled direct in vivo observation of the microcirculation and concepts that have originated from it. METHODS: A MedLine search was conducted for clinical articles in the English language over the last 15 years pertainig to shock, sepsis, organ failure, or critically ill patients in combination with vasoactive drugs and specific variables of organ perfusion/oxygenation (e.g., tonometry, indocyanine clearance, laser Doppler, and sidestream dark field imaging). RESULTS: Eighty original papers evaluating the specific relationship between organ perfusion/oxygenation and the use of vasoactive drugs were identified and are discussed in light of physiological theory of vasomotor tone. CONCLUSIONS: Solid clinical data in support of the idea that increasing blood pressure in shock improves microcirculatory perfusion/oxygenation seem to be lacking, and such a concept might not be in line with physiological theory of microcirculation as a low-pressure vascular compartment. In septic shock no beneficial effect on microcirculatory perfusion above a mean arterial pressure of 65 mmHg has been reported, but a wide range in inter-individual effect seems to exist. Whether improvement of microcirculatory perfusion is associated with better patient outcome remains to be elucidated. |
format | Text |
id | pubmed-2981743 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
spelling | pubmed-29817432010-12-15 The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients Boerma, E. Christiaan Ince, Can Intensive Care Med Review PURPOSE: The clinical use of vasoactive drugs is not only intended to improve systemic hemodynamic variables, but ultimately to attenuate derangements in organ perfusion and oxygenation during shock. This review aims (1) to discuss basic physiology with respect to manipulating vascular tone and its effect on the microcirculation, and (2) to provide an overview of available clinical data on the relation between vasoactive drugs and organ perfusion, with specific attention paid to recent developments that have enabled direct in vivo observation of the microcirculation and concepts that have originated from it. METHODS: A MedLine search was conducted for clinical articles in the English language over the last 15 years pertainig to shock, sepsis, organ failure, or critically ill patients in combination with vasoactive drugs and specific variables of organ perfusion/oxygenation (e.g., tonometry, indocyanine clearance, laser Doppler, and sidestream dark field imaging). RESULTS: Eighty original papers evaluating the specific relationship between organ perfusion/oxygenation and the use of vasoactive drugs were identified and are discussed in light of physiological theory of vasomotor tone. CONCLUSIONS: Solid clinical data in support of the idea that increasing blood pressure in shock improves microcirculatory perfusion/oxygenation seem to be lacking, and such a concept might not be in line with physiological theory of microcirculation as a low-pressure vascular compartment. In septic shock no beneficial effect on microcirculatory perfusion above a mean arterial pressure of 65 mmHg has been reported, but a wide range in inter-individual effect seems to exist. Whether improvement of microcirculatory perfusion is associated with better patient outcome remains to be elucidated. Springer-Verlag 2010-09-02 2010 /pmc/articles/PMC2981743/ /pubmed/20811874 http://dx.doi.org/10.1007/s00134-010-1970-x Text en © The Author(s) 2010 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. |
spellingShingle | Review Boerma, E. Christiaan Ince, Can The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title | The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title_full | The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title_fullStr | The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title_full_unstemmed | The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title_short | The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
title_sort | role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981743/ https://www.ncbi.nlm.nih.gov/pubmed/20811874 http://dx.doi.org/10.1007/s00134-010-1970-x |
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