Exploring the hepatic microcirculation in critical illness: a challenge

A substantial number of patients admitted to the ICU with a major infection develop sepsis or septic shock. The role of the liver and hepatic microcirculation in subsequent events, including organ failure, has been established but continues to be a topic of intensive research. Combined effects on contractile sinusoidal cells i.e. endothelial cells and stellate or Ito cells, regulate the hepatic arterial and venous portal parts of the perfusion in the liver sinusoids with consecutive effects on hepatocyte function and metabolism. However, improving inadequate liver function, based on deficient tissue perfusion and oxygenation, and assessing therapeutic interventions by monitoring the liver microcirculation is difficult. Current monitoring techniques include liver-specific clearance of substances and intravital microscopic visualization of the microcirculation combined with computer-aided video analysis. Simple and minimally invasive bedside monitoring of the microcirculation would be a great advantage in the future.