Current and new therapies for the critically injured microcirculation

For the past 20 years, the microcirculation has been regarded as cornerstone in the development of organ failure in critically ill patients. Eventually, the microcirculation became a therapeutic target. Due to the complexity of the architecture of the microcirculation, varying for one organ to another, one therapy cannot “fit all”. The alterations observed in the critically injured microcirculation involve: the container defined by the different layers of the vascular wall, the contents representing the flowing plasma and its formed elements and the extraluminal surrounding tissue. Thus, a multifaceted approach of these microcirculatory alterations is mandatory to investigate an optimal therapy that will meet the needs so the injured microcirculation will be healed. In this dissertation, the effects of current and new therapies on the critically injured microcirculation are investigated by looking at the different components of microcirculation and subsequent end organ function. Several chapters are focused on the kidney, this organ being one of the primary to be damaged in critical settings.