%0 Journal Article
%T Microcirculation impairment and blood pressure in sepsis
%A Slavica Kvolik
%A Ines Drenjan£¿evi£¿-Peri£¿
%A Ines Taka£¿
%A Marko Juki£¿
%J Medicinski Glasnik
%D 2009
%I Medical Association of Zenica-Doboj Canton
%X Blood pressure is crucial for the tissue perfusion, oxygenation andelimination of metabolites in normal tissue. In septic patients itmay be altered by several mechanisms. Endothelial lesions andimpaired vasoregulation resulting from bacteriemia may producevasodilatation, hypotension, tissue hypoxia and decrease in theblood velocity. These events may favour disseminated intravascularcoagulation in septic patients, and thus pronounce perfusionmisdistribution. Since hypotension is commonly treated byvasoactive drugs to increase vascular tone toward normal values,more pronounced peripheral tissue ischemia may result. Duringthe process of blood pressure regulation in septic patients a diversityof physiological parameters should be encountered, i.e. age,body weight, core temperature, overall patients¡¯ cardiovascularperformance, anemia, and protein status. In a healthy, adult person,in the absence of other causes of hypotension systolic bloodpressure of > 90 mmHg or mean arterial pressure ¡Ý 70 mmHgshould maintain adequate tissue perfusion. Together with specificantibiotics, therapeutic procedures like haemodilution, use of vasoconstrictors,vasopressin and its analogue terlipressin, corticosteroidsare currently used to improve outcome of hypotensive septicpatients. Numerous studies were undertaken to point the valuesof the biochemical tests suggesting a need for prompt intervention.The arterial lactate, cortisol response, TNF, interleukin (IL)6, IL-12p70 and IL-12p40 production, together with submucosal(gastric intramucosal or sublingual) CO2 values were proven as indicative.These may suggest whether microcirculatory impairmentis reversible or not, and which therapeutic maneuver should beappropriate.
%K sepsis
%K shock
%K blood pressure
%K vasoconstrictor agents
%U http://www.ljkzedo.com.ba/medglasnik/vol61/M09_1_4.pdf