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Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms

Sepsis is one of the most frequent causes of death among patients in intensive care units. Many therapeutic strategies have been assessed without the desired success rates. A key risk factor for death is hypotension due to vasodilatation with vascular hyposensitivity. However, the pathways underlyin...

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Detalles Bibliográficos
Autores principales: Burgdorff, A.-M., Bucher, M., Schumann, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091823/
https://www.ncbi.nlm.nih.gov/pubmed/29332515
http://dx.doi.org/10.1177/0300060517743836
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author Burgdorff, A.-M.
Bucher, M.
Schumann, J.
author_facet Burgdorff, A.-M.
Bucher, M.
Schumann, J.
author_sort Burgdorff, A.-M.
collection PubMed
description Sepsis is one of the most frequent causes of death among patients in intensive care units. Many therapeutic strategies have been assessed without the desired success rates. A key risk factor for death is hypotension due to vasodilatation with vascular hyposensitivity. However, the pathways underlying this process remain unclear. Endotoxemia induces inflammatory mediators, and this is followed by vasoplegia and decreased cardiac contractility. Although inhibition of these mediators diminishes mortality rates in animal models, this phenomenon has not been confirmed in humans. Downregulation of vasoconstrictive receptors such as angiotensin receptors, adrenergic and vasopressin receptors is seen in sepsis, which is associated with a hyporesponsiveness to vasoconstrictive mediators. Animal studies have verified that receptor downregulation is linked to the above-mentioned inflammatory mediators. Anti-inflammatory therapy with glucocorticoids reportedly improves responsiveness to catecholamines with higher survival in rats, although this has not been shown to be clinically significant in humans. Hence, there is an urgent need for in-depth studies investigating the underlying mechanisms of vasoplegia to allow for development of effective therapeutic strategies for the treatment of sepsis.
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spelling pubmed-60918232018-08-17 Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms Burgdorff, A.-M. Bucher, M. Schumann, J. J Int Med Res Review Sepsis is one of the most frequent causes of death among patients in intensive care units. Many therapeutic strategies have been assessed without the desired success rates. A key risk factor for death is hypotension due to vasodilatation with vascular hyposensitivity. However, the pathways underlying this process remain unclear. Endotoxemia induces inflammatory mediators, and this is followed by vasoplegia and decreased cardiac contractility. Although inhibition of these mediators diminishes mortality rates in animal models, this phenomenon has not been confirmed in humans. Downregulation of vasoconstrictive receptors such as angiotensin receptors, adrenergic and vasopressin receptors is seen in sepsis, which is associated with a hyporesponsiveness to vasoconstrictive mediators. Animal studies have verified that receptor downregulation is linked to the above-mentioned inflammatory mediators. Anti-inflammatory therapy with glucocorticoids reportedly improves responsiveness to catecholamines with higher survival in rats, although this has not been shown to be clinically significant in humans. Hence, there is an urgent need for in-depth studies investigating the underlying mechanisms of vasoplegia to allow for development of effective therapeutic strategies for the treatment of sepsis. SAGE Publications 2018-01-14 2018-04 /pmc/articles/PMC6091823/ /pubmed/29332515 http://dx.doi.org/10.1177/0300060517743836 Text en © The Author(s) 2018 https://creativecommons.org/licenses/by-nc/4.0/Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Burgdorff, A.-M.
Bucher, M.
Schumann, J.
Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title_full Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title_fullStr Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title_full_unstemmed Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title_short Vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
title_sort vasoplegia in patients with sepsis and septic shock: pathways and mechanisms
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091823/
https://www.ncbi.nlm.nih.gov/pubmed/29332515
http://dx.doi.org/10.1177/0300060517743836
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