Microcirculation as Related to Shock

Microcirculation as Related to Shock

1st Edition - January 1, 1968

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  • Editor: David Shepro
  • eBook ISBN: 9780323157131

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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.

Table of Contents

  • List of Contributors

    Acknowledgment of Assistance



    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


    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


    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


    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


    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


    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


    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


    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


    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


    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


    11. Rheological Aspects of Low Flow States

    I. Introduction

    II. Pathophysiological Mechanisms and Rheology

    III. Rheological Analysis of Microcirculation in Man

    IV. Conclusions


    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


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


    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


    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


    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

Product details

  • No. of pages: 296
  • Language: English
  • Copyright: © Academic Press 1968
  • Published: January 1, 1968
  • Imprint: Academic Press
  • eBook ISBN: 9780323157131

About the Editor

David Shepro

Affiliations and Expertise

Boston University, Massachusetts, U.S.A.

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