Role of the interstitium during septic shock: a key to the understanding of fluid dynamics?

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
Auguste Dargent, Hugo Dumargne, Marie Labruyère, Stéphane Brezillon, Sylvie Brassart-Pasco, Mathieu Blot, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Pierre Quenot, Marine Jacquier
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Abstract

Background: While not traditionally included in the conceptual understanding of circulation, the interstitium plays a critical role in maintaining fluid homeostasis. Fluid balance regulation is a critical aspect of septic shock, with a well-known association between fluid balance and outcome. The regulation of transcapillary flow is the first key to understand fluid homeostasis during sepsis.

Main text: Capillary permeability is increased during sepsis, and was classically considered to be necessary and sufficient to explain the increase of capillary filtration during inflammation. However, on the other side of the endothelial wall, the interstitium may play an even greater role to drive capillary leak. Indeed, the interstitial extracellular matrix forms a complex gel-like structure embedded in a collagen skeleton, and has the ability to directly attract intravascular fluid by decreasing its hydrostatic pressure. Thus, interstitium is not a mere passive reservoir, as was long thought, but is probably major determinant of fluid balance regulation during sepsis. Up to this date though, the role of the interstitium during sepsis and septic shock has been largely overlooked. A comprehensive vision of the interstitium may enlight our understanding of septic shock pathophysiology. Overall, we have identified five potential intersections between septic shock pathophysiology and the interstitium: 1. increase of oedema formation, interacting with organ function and metabolites diffusion; 2. interstitial pressure regulation, increasing transcapillary flow; 3. alteration of the extracellular matrix; 4. interstitial secretion of inflammatory mediators; 5. decrease of lymphatic outflow.

Conclusions: We aimed at reviewing the literature and summarizing the current knowledge along these specific axes, as well as methodological aspects related to interstitium exploration.

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间质在感染性休克中的作用:理解流体动力学的关键?
背景:虽然传统上不包括在对循环的概念理解中,但间质在维持流体稳态方面发挥着关键作用。液体平衡调节是感染性休克的一个关键方面,众所周知,液体平衡与结果之间存在关联。经毛细血管血流的调节是了解败血症期间液体稳态的第一个关键。正文:败血症期间毛细血管通透性增加,经典地认为这是解释炎症期间毛细血管滤过增加的必要和充分的。然而,在内皮壁的另一侧,间质可能在驱动毛细血管渗漏方面发挥更大的作用。事实上,间质细胞外基质在胶原骨架中形成复杂的凝胶状结构,并具有通过降低其静水压直接吸引血管内液体的能力。因此,间质并不像人们长期认为的那样仅仅是一个被动的储库,而是败血症期间液体平衡调节的主要决定因素。然而,到目前为止,间质在败血症和感染性休克中的作用在很大程度上被忽视了。对间质的全面了解可能会加深我们对感染性休克病理生理学的理解。总的来说,我们已经确定了感染性休克病理生理学和间质之间的五个潜在交叉点:1。水肿形成增加,与器官功能和代谢产物扩散相互作用;2.间质压力调节,增加经毛细血管流量;3.细胞外基质的改变;4.炎症介质的间质分泌;5.淋巴流出减少。结论:我们旨在回顾文献,总结目前沿着这些特定轴线的知识,以及与间质探索相关的方法论方面。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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