What are the microcirculatory characteristics during the refractory stage of shock?
May 31, 2023
Source: Cainiu Health
Dr. Yang Shuwen
Introduction
The refractory stage of shock is the late phase of shock development, also known as the terminal stage of shock. In this stage, the response to therapeutic interventions for shock is diminished, and irreversible multiple organ dysfunction may occur. Generally, microcirculatory characteristics of the refractory stage of shock include aggravated microcirculatory impairment, reduced vascular resistance in the microcirculation, increased osmotic pressure, and decreased red blood cell deformability.
The refractory stage of shock is the late phase of shock development, also known as the terminal stage of shock. At this stage, the patient's response to therapeutic interventions for shock is diminished, and irreversible multiple organ dysfunction may occur. Generally, microcirculatory characteristics during the refractory stage of shock include exacerbated microcirculatory impairment, reduced microvascular resistance, increased osmotic pressure, and decreased red blood cell deformability. Specific details are as follows:
1. Exacerbated microcirculatory impairment: Due to persistently low blood pressure during shock, local ischemia and hypoxia develop, leading to worsening microcirculatory dysfunction.
2. Reduced microvascular resistance: Under normal conditions, microvessels maintain a certain level of vascular tone. However, in the refractory stage of shock, endothelial cell function in the microcirculation becomes impaired. Additionally, factors such as tissue hypoxia and acid-base imbalances contribute to decreased microvascular resistance.
3. Increased osmotic pressure and decreased red blood cell deformability: During the refractory stage of shock, peripheral microcirculatory blood flow decreases, blood viscosity increases, red blood cell deformability declines, and plasma osmotic pressure rises, resulting in significant damage to the microcirculation.
In addition, other features include increased release from microvascular endothelial cells and inflammatory cells, as well as accumulation of non-cellular components within capillaries. Physicians typically initiate aggressive emergency treatment, and family members are advised to cooperate closely with medical staff in resuscitating the patient.
