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Microcirculatory dysfunction in sepsis

Microcirculation is a network of small blood vessels of <100 μm diameter. It includes arterioles, capillaries and venules.Its main function is to regulate the blood flow and distribution of flow to various organ systems. Dysfunction of microcirculatory systemis one of the important pathophysiologic process in sepsis evolution. In septic shock, microcirculatory dysfunction is due to endothelial dysfunction, coagulation abnormalities, tissue inflammation, hemorheologic abnormalities, functional shunting and leukocyte-endothelium interactions. Various biomarkers are surrogate markers of measuring microcirculatory dysfunction, however, direct visualization of capillaries using video microscopic techniques is the gold standard. Therapeutic intervention for managing septic shock are mainly titrated on microcirculatory parameters and do not corelate directly with improvement at microcirculatory levels. More data is needed on practical bedside monitoring of microcirculation and titrating the therapy based on that.