Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Mechanisms of critical illness – classifying microcirculatory flow abnormalities in distributive shock. | Available online http content 10 4 221 Review Bench-to-bedside review Mechanisms of critical illness -classifying microcirculatory flow abnormalities in distributive shock Paul WG Elbers1 2 and Can Ince1 1 Department of Physiology Academic Medical Center University of Amsterdam Amsterdam The Netherlands 2Department of Anesthesiology Intensive Care and Pain Management St Antonius Hospital Nieuwegein The Netherlands Corresponding author Can Ince Published 19 July 2006 This article is online at http content 10 4 221 2006 BioMed Central Ltd Critical Care 2006 10 221 doi cc4969 Abstract Over 30 years ago Weil and Shubin proposed a re-classification of shock states and identified hypovolemic cardiogenic obstructive and distributive shock. The first three categories have in common that they are associated with a fall in cardiac output. Distributive shock such as occurs during sepsis and septic shock however is associated with an abnormal distribution of microvascular blood flow and metabolic distress in the presence of normal or even supranormal levels of cardiac output. This Bench-to-bedside review looks at the recent insights that have been gained into the nature of distributive shock. Its pathophysiology can best be described as a microcirculatory and mitochondrial distress syndrome where time and therapy form an integral part of the definition. The clinical introduction of new microcirculatory imaging techniques such as orthogonal polarization spectral and sidestream dark-field imaging have allowed direct observation of the microcirculation at the bedside. Images of the sublingual microcirculation during septic shock and resuscitation have revealed that the distributive defect of blood flow occurs at the capillary level. In this paper we classify the different types of heterogeneous flow patterns of microcirculatory abnormalities found during different types of distributive shock. Analysis of these patterns gave a five
