Microcirculatory disorders during septic shock.

PURPOSE OF REVIEW: Despite the progress made over the past 20 years in the treatment of septic shock, mortality remains high. Microcirculatory disorders raise considerable interest aiming to improve the understanding of the physiopathology of septic shock and its management.

RECENT FINDINGS: Numerous experimental and clinical studies have gradually focused on the analysis of microcirculatory blood flow and identified alterations in small vessels. These microcirculatory abnormalities appear early, are heterogeneous, and are directly linked to organ failure, as well as the patient's prognosis. These anomalies vary from one patient to the other, and their evolution during resuscitation cannot be predicted by the isolated analysis of global hemodynamic parameters such as blood pressure or heart rate.

SUMMARY: Microcirculatory disorders appear at a central place of the physiopathology and are highly associated with the patient prognosis; it therefore seems important to develop and integrate parameters reflecting tissue perfusion in the management of septic shock.