Richard Ivey Critical Care Trauma Centre, Victoria Hospital, London, Canada.
Circulatory disturbances in MSOF disturb normal metabolic autoregulation, the ability to continuously couple tissue oxygen delivery with oxygen need. These may occur at three levels of the circulation: the heart; the regional circulations; and the microcirculation. This article will summarize evidence demonstrating that MSOF is associated with reduced tissue oxygen delivery by virtue of changes in all three circulatory components governing the inadequacy of metabolic autoregulation in sepsis.