Microcirculation as Related to Shock

1st Edition - November 10, 2012
Editor: David Shepro
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 4 3 3 4 0 1 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 1 5 7 1 3 - 1

Microcirculation as Related to Shock contains the proceedings of the 1967 Conference on the Microcirculation as Related to Shock held at Boston University. Contributors address… Read more

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Microcirculation as Related to Shock contains the proceedings of the 1967 Conference on the Microcirculation as Related to Shock held at Boston University. Contributors address reduced blood flow in the microcirculation and microcirculatory hypoperfusion as the focal point of shock. They also review significant progress in shock research, basic cardiovascular physiology, and cognate interdisciplinary fields. This volume is organized into four sections encompassing 26 chapters and begins with an overview of organs and systems involved in shock, including splanchnic circulation, regulatory mechanisms in shock, and microcirculatory studies in hypotension. The next chapters explore the causative factors that produce the state of low blood flow as found in shock, and whether microcirculatory hypoperfusion in humans can be prevented and treated. The book also discusses whether microcirculatory hypoperfusion can be measured in the patient and concludes with an assessment of promising avenues for further research, emphasizing the measurement of blood viscosity, shear stress, and rheological factors as indices of the degree of hypotension. This book is a valuable source of information for physiologists, biologists, and pathologists, as well as those involved in the medical sciences.

List of Contributors

Acknowledgment of Assistance

Preface

Introduction

Part I: Organs and Systems Involved in Shock

1. The Splanchnic Microcirculation in Shock and Hypotension

I. Introduction

II. Contribution of Splanchnic Circulation to Shock

III. Observations of the Microcirculation

IV. Regulatory Mechanisms in Shock

V. Central Nervous System Effects in Shock

VI. Microcirculatory Studies in Hypotension

VII. Conclusions

VIII. Precis: Commentary of Discussants

References

2. Aspects of the Pulmonary Microcirculation

I. Introduction

II. Distribution of Pulmonary Blood Flow

III. Factors Determining the Amount of Unperfused Lung

IV. Histological Appearance of Unperfused Lung

V. Effects of Pulmonary Hypotension on Gas Exchange

VI. Consequences of a Raised Pulmonary Venous Pressure

VII. Precis: Commentary of Discussants

References

3. Autoregulation in Skeletal Muscle During Shock

I. Introduction

II. Experimental Procedures

III. Hind Leg Blood Flow Following Hemorrhage

IV. Conclusions

V. Precis: Commentary of Discussants

References

4. The Microcirculation of the Heart in Reduced Flow States

I. Introduction

II. Normal Left Coronary Inflow

III. Reduced Flow State—Coronary Insufficiency

IV. Transmural Gradients

V. Reduced Flow State—Hemorrhagic Shock

VI. Summary

VII. Precis: Commentary of Discussants

References

5. Cutaneous Circulation : A Clouded Window

I. Introduction

II. Difficulties in Using to Study Circulation

III. Heterogeneity of the Skin

IV. Unique Features of the Skin

V. Conclusions

VI. Precis: Commentary of Discussants

References

6. The Retinal Microcirculation in Shock

I. Introduction

II. Synopsis of Procedure

III. Effect of Hemorrhage Alone

IV. Effect of Hemorrhage after Embolization

V. Discussion of Experimental Results

VI. Precis: Commentary of Discussants

References

7. Cerebral Vascular Responses to Localized and Systemic Hypotension Induced by Hemorrhage and Shock

I. Introduction

II. Review: Cerebral Blood Flow Studies

III. Cerebral Circulation in Dogs during Hemorrhagic Shock

IV. Control Studies

V. Summary

VI. Precis: Commentary of Discussants

References

8. Kidney Circulation During Hemorrhagic Hypotension

I. Introduction

II. Reduced Perfusion Pressure

III. Influence of Humoral Vasoconstrictors

IV. Effects of Neurogenic Stimuli

V. Conclusions

VI. Precis: Commentary of Discussants

References

Part II: Special Aspects of Low Flow States

9. Neurogenic Factors in Microcirculatory Low Flow States

I. Introduction: Functions of the Peripheral Blood Vessels

II. Control of Peripheral Microvascular Effectors

III. Interaction of Control Mechanisms

IV. Conclusions

References

10. Local Humoral Factors Influencing the Microcirculation in Shock

I. Introduction

II. Effects of Heat Shock

III. Responses to Tourniquet and Traumatic Shocks

IV. Injury Shock

V. Dextran and Ovomucoid Shock

VI. Inflammatory Responses to Chemically Induced Shocks

VII. Other Factors Involved in Shock

VIII. Summary

References

11. Rheological Aspects of Low Flow States

I. Introduction

II. Pathophysiological Mechanisms and Rheology

III. Rheological Analysis of Microcirculation in Man

IV. Conclusions

References

12. Traumatic and Toxic Factors in Shock

I. Introduction

II. Agents That May Cause or Contribute to the Shock State

III. Toxins as a Primary Causative Factor of Shock

IV. Physiological and Hemodynamic Observations in Man

V. Management of Shock in Man

VI. Conclusions

References

13. Precis: Commentary of Discussants. Special Aspects of Low Flow States

Text

Part III: Workshops

14. Summary of Workshop Sessions

I. Introduction

II. Tracer Techniques for Flow and Transport

III. Video Scanning Procedures

IV. Micro-Blood Pressure Measurements

V. Rheological Methods

VI. Calorimetric Methods

VII. Techniques for Studying Vascular Smooth Muscle and Its Innervation

VIII. Systems Approach to Shock and Microcirculation

References

Part IV: Relevance and Conclusions of the Conference

15. Physiological Indices of Hypoperfusion in Man

I. Introduction

II. Indices of General Hypoperfusion

III. Local or Regional Indices of Hypoperfusion

IV. Conclusions

References

16. General Considerations

I. Aims of the Conference

II. Causative Factors of Shock: Some Areas of General Agreement

III. Systematic Alterations Affecting the Microcirculation and Contribution to Low Flow States

IV. Microcirculatory Autoregulation in the Shock State

V. Flow Properties under Reduced Pressure and Elevated Venous Resistance

VI. "Peripheral Circulatory Failure"

VII. "Nutritional Shunting"

VIII. Nutritional Elements and Local Adjustments of the Microcirculation

IX. Venous Resistance

X. The Heart and Other "Shock Organs"

XI. Eye and Skin: Windows to the Microcirculation

Author Index

Subject Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Microcirculation as Related to Shock

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David Shepro