Figure 1

The microcirculation is the motor of sepsis. Circulatory failure as a result of sepsis can be initiated by various insults such as trauma, infection, and shock. Its treatment is initially based on correction of systemic variables. Microcirculatory distress can persist and remain undetected, a condition termed microcirculatory and mitochondrial distress syndrome (MMDS). Here, time and therapy contribute to its definition and nature. Left uncorrected, the different cellular and inflammatory components of the distressed microcirculation interact and increase in severity, fueling the respiratory distress of the parenchymal cells and ultimately leading to organ failure.