Critical oxygen delivery: the crux of bypass with a special look at the microcirculation.

The microcirculation can be defined as those vascular structures where respiratory gas flux occurs. These are generally the arterioles, venules, and capillaries. Larger vascular conduits tend to have thicker walls, are at considerable distance from cellular sites of oxygen utilization, and therefore contribute little to oxygen flux. The microcirculation is complex, not a simple straight line of parallel groups of pipes with unidirectional flow. Rather, the complex network has most vascular structures not open (held in reserve) and often has bidirectional flow. Understanding the movement of O2, CO2, and other gases within this network has only recently been the center of focused research. The cardiopulmonary bypass machine is meant to keep the microcirculation normal, but research is demonstrating major changes within. This review looks at what is known today in spontaneously perfusing animals as well as early findings noting differences in cardiopulmonary bypass. We, as yet, do not understand all the mechanisms involved in the changes of the microcirculation so thoughts regarding future areas for research are discussed.