1
|
Ranjit S, Natraj R, Kissoon N, Thiagarajan RR, Ramakrishnan B, Monge García MI. Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock. Pediatr Crit Care Med 2021; 22:e448-e458. [PMID: 33750093 DOI: 10.1097/pcc.0000000000002714] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min). A clinically significant response in cardiac index-responder and mean arterial pressure-responder was both defined as an increase of greater than or equal to 10% 10 minutes after fluid bolus. MEASUREMENTS AND MAIN RESULTS Forty-two children with septic shock, 1 month to 16 years old, median Pediatric Risk of Mortality-III of 13 (interquartile range, 9-19), of whom 66% were hypotensive and received fluid bolus within the first hour of shock recognition. Cardiac index- and mean arterial pressure-responsiveness rates were 31% and 38%, respectively. We failed to identify any association between cardiac index and mean arterial pressure changes (r = 0.203; p = 0.196). Cardiac function was similar in mean arterial pressure- and cardiac index-responders and nonresponders. Mean arterial pressure-responders increased systolic, diastolic, and perfusion pressures (mean arterial pressure - central venous pressure) after fluid bolus due to higher indexed systemic vascular resistance and arterial elastance index. Mean arterial pressure-nonresponders required greater vasoactive-inotrope support and had higher mortality. CONCLUSIONS The hemodynamic response to fluid bolus in pediatric septic shock was variable and unpredictable. We failed to find a relationship between mean arterial pressure and cardiac index changes. The adverse effects of fluid bolus extended beyond fluid overload and, in some cases, was associated with reduced mean arterial pressure, perfusion pressures and higher vasoactive support. Mean arterial pressure-nonresponders had increased mortality. The response to the initial fluid bolus may be helpful to understand each patient's individualized physiologic response and guide continued hemodynamic management.
Collapse
Affiliation(s)
| | | | - Niranjan Kissoon
- The University of British Columbia, The Child and Family Research Institute, and BC Children's Hospital, Vancouver, BC, Canada
| | - Ravi R Thiagarajan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - M Ignacio Monge García
- Servicio de Cuidados Críticos y Urgencias Hospital SAS de Jerez C/Circunvalación s/n, Jerez de la Frontera, Spain
| |
Collapse
|
2
|
Lafon T, Feydeau P, Baisse A, Bigrat V, Raynaud C, Pihan M, Goudelin M, Evrard B, Vallejo C, Karam HH, Vignon P. Évaluation hémodynamique précoce par échocardiographie ciblée des patients en sepsis ou choc septique (Sepsis-3) au service d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : L’identification du profil hémodynamique des patients septiques au service d’urgence (SU) pourrait permettre d’adapter individuellement les recommandations de la Surviving Sepsis Campaign (SSC). L’objectif de cette étude était de décrire le profil hémodynamique précoce par échocardiographie ciblée chez les patients en sepsis et leur impact thérapeutique.
Méthode : Étude prospective monocentrique incluant les patients septiques (score qSOFA [quick Sepsis-related Organ Failure Assessment] ≥ 2) sur une période de 30 mois. L’échocardiographie était réalisée par des médecins urgentistes de niveau échographie clinique en médecine d’urgence 1 afin de déterminer le profil hémodynamique (hypovolémie, vasoplégie avec hyperkinésie, insuffisance ventriculaire ou profil « normal ») dès le sepsis identifié au SU. L’impact thérapeutique était défini par le nombre de patients pour lesquels l’échocardiographie modifiait le traitement de la SSC.
Résultats : Quatre-vingt-un patients (44 sepsis, 37 chocs septiques) ont été étudiés (âge moyen : 70 ± 15 ans ; hommes [n = 47, 58 %] ; SOFA = 5,3 ± 2,9 ; lactates = 4,6 ± 4,2 mmol/l ; admission en réanimation [n = 30, 37 %] ; mortalité j28 [n = 28, 35 %]) après un remplissage vasculaire médian de 500 ml (écart interquartile : 250–1 500 ml). Les profils hémodynamiques dominants étaient l’hypovolémie (n = 54, 66 %), parfois associée à une vasoplégie (n = 26, 32 %) et l’insuffisance ventriculaire (n = 21, 26 %). L’impact thérapeutique concernait 21 patients (26 %), dont un arrêt précoce du remplissage vasculaire après un volume de 850 ± 740 ml chez huit patients.
Conclusion : La dysfonction ventriculaire précoce est présente chez plus de 20 % des patients septiques. L’impact pronostique d’une évaluation échocardiographique dès l’identification du sepsis au SU reste à déterminer.
Collapse
|
3
|
Cardiovascular effects of increasing dosages of norepinephrine in healthy isoflurane-anesthetized New Zealand White rabbits. Vet Anaesth Analg 2020; 47:781-788. [PMID: 32826161 DOI: 10.1016/j.vaa.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To characterize the cardiovascular effects of increasing dosages of norepinephrine (NE) in healthy isoflurane-anesthetized rabbits. STUDY DESIGN Prospective experimental study. ANIMALS A total of nine female ovariohysterectomized New Zealand White rabbits weighing 3.4 ± 0.2 kg (mean ± standard deviation). METHODS Rabbits were premedicated intramuscularly with buprenorphine (0.05 mg kg-1) and midazolam (0.5 mg kg-1). Anesthesia was induced with intravenous propofol and maintained with a 1.1 × minimum alveolar concentration of isoflurane for this species to induce hypotension. Rabbits were administered NE infusions at three doses: low, 0.1 μg kg-1 minute-1; medium, 0.5 μg kg-1 minute-1; and high doses, 1 μg kg-1 minute-1 for 10 minutes each in that order. Cardiovascular variables including heart rate (HR), cardiac output (CO) by lithium dilution technique and systolic (SAP), mean (MAP) and diastolic (DAP) invasive arterial blood pressures measured in the auricular artery were recorded at baseline, 10 minutes after the start of the infusion of each NE treatment and 10 minutes after NE was discontinued. A linear mixed model and a type III anova with Tukey's post hoc comparison was performed (p < 0.05). RESULTS Significant increases in SAP (28% and 90%), MAP (27% and 90%) and DAP (33% and 97%) were measured with medium and high dose treatments, respectively (p < 0.001), with no changes in CO. HR decreased and stroke volume increased significantly with high dose treatment (by 17% and 15%, respectively; p < 0.05). No arrhythmias were noticed with NE treatments. CONCLUSIONS AND CLINICAL RELEVANCE The infusion of NE at 0.5-1.0 μg kg-1 minute-1 is a potentially effective treatment for hypotension in healthy isoflurane-anesthetized New Zealand White rabbits.
Collapse
|
4
|
Marik PE, Byrne L, van Haren F. Fluid resuscitation in sepsis: the great 30 mL per kg hoax. J Thorac Dis 2020; 12:S37-S47. [PMID: 32148924 DOI: 10.21037/jtd.2019.12.84] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Large volume fluid resuscitation is currently viewed as the cornerstone of the treatment of septic shock. The surviving sepsis campaign (SSC) guidelines provide a strong recommendation to rapidly administer a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock and those with elevated blood lactate levels. However, there is no credible evidence to support this recommendation. In fact, recent findings from experimental, observational and randomized clinical trials demonstrate improved outcomes with a more restrictive approach to fluid resuscitation. Accumulating evidence suggests that aggressive fluid resuscitation is harmful. Paradoxically, excess fluid administration may worsen shock. In this review, we critically evaluate the scientific evidence for a weight-based fluid resuscitation approach. Furthermore, the potential mechanisms and consequences of harm associated with fluid resuscitation are discussed. Finally, we recommend an individualized, conservative and physiologic guided approach to fluid resuscitation.
Collapse
Affiliation(s)
- Paul E Marik
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Liam Byrne
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
| | - Frank van Haren
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia
| |
Collapse
|
5
|
Begot E, Vignon P. Dysfonction cardiaque au cours du sepsis : mythe ou réalité ? MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
Gonzalez C, Begot E, Dalmay F, Pichon N, François B, Fedou AL, Chapellas C, Galy A, Mancia C, Daix T, Vignon P. Prognostic impact of left ventricular diastolic function in patients with septic shock. Ann Intensive Care 2016; 6:36. [PMID: 27099042 PMCID: PMC4839020 DOI: 10.1186/s13613-016-0136-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/28/2016] [Indexed: 01/10/2023] Open
Abstract
Background Left ventricular (LV) diastolic dysfunction is highly prevalent in the general population and associated with a significant morbidity and mortality. Its prognostic role in patients sustaining septic shock in the intensive care unit (ICU) remains controversial. Accordingly, we investigated whether LV diastolic function was independently associated with ICU mortality in a cohort of septic shock patients assessed using critical care echocardiography. Methods Over a 5-year period, patients hospitalized in a Medical–Surgical ICU who underwent an echocardiographic assessment with digitally stored images during the initial management of a septic shock were included in this retrospective single-center study. Off-line echocardiographic measurements were independently performed by an expert in critical care echocardiography who was unaware of patients’ outcome. LV diastolic dysfunction was defined by the presence of a lateral E′ maximal velocity <10 cm/s. A multivariate analysis was performed to determine independent risk factors associated with ICU mortality. Results Among the 540 patients hospitalized in the ICU with septic shock during the study period, 223 were studied (140 men [63 %]; age 64 ± 13 years; SAPS II 55 ± 18; SOFA 10 ± 3; Charlson 3.5 ± 2.5) and 204 of them (91 %) were mechanically ventilated. ICU mortality was 35 %. LV diastolic dysfunction was observed in 31 % of patients. The proportion of LV diastolic dysfunction tended to be higher in non-survivors than in their counterparts (28/78 [36 %] vs. 41/145 [28 %]: p = 0.15). Inappropriate initial antibiotic therapy (OR 4.17 [CI 95 % 1.33–12.5]: p = 0.03), maximal dose of vasopressors (OR 1.38 [CI 95 % 1.16–1.63]: p = 0.01), SOFA score (OR 1.16 [CI 95 % 1.02–1.32]: p = 0.02) and lateral E′ maximal velocity (OR 1.12 [CI 95 % 1.01–1.24]: p = 0.02) were independently associated with ICU mortality. After adjusting for the SAPS II score, inappropriate initial antibiotic therapy and maximal dose of vasopressors remained independent factors for ICU mortality, whereas a trend was only observed for lateral E′ maximal velocity (OR 1.11 [CI 95 % 0.99–1.23]: p = 0.07). Conclusion The present study suggests that LV diastolic function might be associated with ICU mortality in patients with septic shock. A multicenter prospective study assessing a large cohort of patients using serial echocardiographic examinations remains required to confirm the prognostic value of LV diastolic dysfunction in septic shock.
Collapse
Affiliation(s)
- Céline Gonzalez
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France
| | - Emmanuelle Begot
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France
| | - François Dalmay
- Department of Biostatistics, Dupuytren Teaching Hospital, Limoges, France
| | - Nicolas Pichon
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France
| | - Bruno François
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France.,UMR 1092, University of Limoges, Limoges, France
| | - Anne-Laure Fedou
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France
| | | | - Antoine Galy
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France
| | - Claire Mancia
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France
| | - Thomas Daix
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France
| | - Philippe Vignon
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Limoges, France. .,Inserm CIC 1435, Dupuytren Teaching Hospital, Limoges, France. .,UMR 1092, University of Limoges, Limoges, France. .,Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87000, Limoges, France.
| |
Collapse
|
7
|
Vignon P, Huang SJ. Global longitudinal strain in septic cardiomyopathy: the hidden part of the iceberg? Intensive Care Med 2015; 41:1851-3. [PMID: 26183488 DOI: 10.1007/s00134-015-3962-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Philippe Vignon
- Réanimation Polyvalente, CHU Limoges, 2 Avenue Martin Luther King, 87000, Limoges Cedex, France. .,INSERM, CIC1435, 87000, Limoges, France. .,Université Limoges, UMR1092, Limoges, France.
| | - Stephen J Huang
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, NSW, 2750, Australia
| |
Collapse
|
8
|
Monge García MI, Guijo González P, Gracia Romero M, Gil Cano A, Oscier C, Rhodes A, Grounds RM, Cecconi M. Effects of fluid administration on arterial load in septic shock patients. Intensive Care Med 2015; 41:1247-55. [DOI: 10.1007/s00134-015-3898-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
|
9
|
Chan GSH, Tang CHH, Middleton PM, Cave G, Harvey M, Savkin AV, Lovell NH. Augmented photoplethysmographic low frequency waves at the onset of endotoxic shock in rabbits. Physiol Meas 2010; 31:1605-21. [DOI: 10.1088/0967-3334/31/12/004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
10
|
Jianhui L, Rosenblatt-Velin N, Loukili N, Pacher P, Feihl F, Waeber B, Liaudet L. Endotoxin impairs cardiac hemodynamics by affecting loading conditions but not by reducing cardiac inotropism. Am J Physiol Heart Circ Physiol 2010; 299:H492-501. [PMID: 20525873 PMCID: PMC2930391 DOI: 10.1152/ajpheart.01135.2009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 06/03/2010] [Indexed: 12/25/2022]
Abstract
Acute myocardial dysfunction is a typical manifestation of septic shock. Experimentally, the administration of endotoxin [lipopolysacharride (LPS)] to laboratory animals is frequently used to study such dysfunction. However, a majority of studies used load-dependent indexes of cardiac function [including ejection fraction (EF) and maximal systolic pressure increment (dP/dt(max))], which do not directly explore cardiac inotropism. Therefore, we evaluated the direct effects of LPS on myocardial contractility, using left ventricular (LV) pressure-volume catheters in mice. Male BALB/c mice received an intraperitoneal injection of E. coli LPS (1, 5, 10, or 20 mg/kg). After 2, 6, or 20 h, cardiac function was analyzed in anesthetized, mechanically ventilated mice. All doses of LPS induced a significant drop in LV stroke volume and a trend toward reduced cardiac output after 6 h. Concomitantly, there was a significant decrease of LV preload (LV end-diastolic volume), with no apparent change in LV afterload (evaluated by effective arterial elastance and systemic vascular resistance). Load-dependent indexes of LV function were markedly reduced at 6 h, including EF, stroke work, and dP/dt(max). In contrast, there was no reduction of load-independent indexes of LV contractility, including end-systolic elastance (ejection phase measure of contractility) and the ratio dP/dt(max)/end-diastolic volume (isovolumic phase measure of contractility), the latter showing instead a significant increase after 6 h. All changes were transient, returning to baseline values after 20 h. Therefore, the alterations of cardiac function induced by LPS are entirely due to altered loading conditions, but not to reduced contractility, which may instead be slightly increased.
Collapse
Affiliation(s)
- Li Jianhui
- Department of Intensive Care Medicine, and
- Department of Hepatobiliary Surgery, the First Affiliated Hospital, Zhejiang University, College of Medicine, Hangzhou, China; and
| | - Nathalie Rosenblatt-Velin
- Division of Clinical Pathophysiology, University Hospital Center and Faculty of Biology and Medicine, Lausanne, Switzerland
| | | | - Pal Pacher
- Laboratory of Physiologic Studies, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - François Feihl
- Division of Clinical Pathophysiology, University Hospital Center and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Bernard Waeber
- Division of Clinical Pathophysiology, University Hospital Center and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Lucas Liaudet
- Department of Intensive Care Medicine, and
- Division of Clinical Pathophysiology, University Hospital Center and Faculty of Biology and Medicine, Lausanne, Switzerland
| |
Collapse
|
11
|
Liet JM, Jacqueline C, Orsonneau JL, Gras-Leguen C, Potel G, Rozé JC. The effects of milrinone on hemodynamics in an experimental septic shock model. Pediatr Crit Care Med 2005; 6:195-9. [PMID: 15730608 DOI: 10.1097/01.pcc.0000155636.53455.96] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the specific hemodynamic effects of the phosphodiesterase inhibitor milrinone in a rabbit model of septic shock in the absence of any other treatment. DESIGN A prospective, controlled, interventional study. Animal Model: Fourteen sedated New Zealand rabbits. SETTING Research laboratory of a health sciences university. INTERVENTIONS Rabbits were anesthetized and vascular catheters inserted in femoral artery and jugular vein. After a stabilization period and the recording of baseline measurements (H0), all animals received a 10-mL infusion of Pseudomonas aeruginosa. Two hours later (H2rabbits were randomly assigned to receive 5% dextrose (control group) or milrinone (milrinone group). MEASUREMENTS AND MAIN RESULTS Mean arterial blood pressure (MAP) was monitored continuously, and a cardiac index (CI) was determined every 30 mins by a transpulmonary thermodilution technique using an integrated monitoring device (PICCO). No differences were detected between the two groups after stabilization (H0) or before the treatment (H2) for either CI (mL/min(-1)/kg(-1)) or MAP (mm Hg). CI decreased progressively in the control group during the following 4 hrs, but not in the treated group (at H6: 122 +/- 4 vs. 207 +/- 16 mL/min(-1)/kg(-1); p < .05). No drop of MAP occurred after milrinone infusion. A comparison of the treated and control group reveals that milrinone improved tissue perfusion as evidenced by measurements of central venous saturation (at H4: 0.59 +/- 0.05 vs. 0.71 +/- 0.03, p = .04), lactacidemia (at H6: 10.3 +/- 2.4 vs. 3.9 +/- 0.9 mmol/L, p = .03), creatinemia (at H6: 95 +/- 11 vs. 60 +/- 5 micromol/L, p = .02) and survival (at H6: 5 vs. 7, not significant). CONCLUSION Milrinone improves cardiac output and tissue perfusion in a rabbit model involving severe septic shock.
Collapse
Affiliation(s)
- Jean-Michel Liet
- Pediatric Intensive Care Unit and the Department of Medical Biochemistry, University Hospital of Nantes, France
| | | | | | | | | | | |
Collapse
|
12
|
Albert M, Losser MR, Hayon D, Faivre V, Payen D. Systemic and renal macro- and microcirculatory responses to arginine vasopressin in endotoxic rabbits. Crit Care Med 2004; 32:1891-8. [PMID: 15343018 DOI: 10.1097/01.ccm.0000139708.10718.e3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arginine vasopressin is being used increasingly to treat vasodilatory hypotension, although little is known of its effects on regional perfusion. Arginine vasopressin hemodynamic effects in physiology are mainly mediated through the V1a receptor on blood vessels. To investigate this further, we studied the effect of arginine vasopressin on systemic and renal blood flow in anesthetized, ventilated rabbits given either intravenous saline or endotoxin, and the impact of blocking V1a receptors. DESIGN Prospective, randomized, controlled study. SETTING Animal research laboratory. SUBJECTS Male White New Zealand rabbits. INTERVENTIONS Measurement was made of mean arterial blood pressure, aortic and renal blood flow velocities (pulsed Doppler), and renal cortical and medullary flow (laser Doppler). MEASUREMENTS AND MAIN RESULTS In a first series of animals, incremental intravenous boluses of arginine vasopressin ranging from 1 to 1000 ng were administered 90 mins postendotoxin or saline. In control rabbits (n = 9), increasing doses of arginine vasopressin elevated mean arterial blood pressure but reduced both aortic and renal blood flow velocity and renal cortical flow (p <.05). In endotoxic animals (n = 6), arginine vasopressin produced a similar increase in mean arterial blood pressure although aortic flow was maintained while renal blood flow velocity increased, mostly in its diastolic component (p <.05). Pretreatment with the V1a receptor antagonist in a second series of animals blunted all the effects observed in both control (n = 5) and endotoxic (n = 6) animals, suggesting that arginine vasopressin acted mainly through V1a subtype in this early phase of sepsis. CONCLUSIONS Preservation of renal blood flow with arginine vasopressin during endotoxemia, in particular to the cortex, suggests it could be a promising agent for hemodynamic support during septic shock.
Collapse
Affiliation(s)
- Martin Albert
- Critical Care Division, Royal Victoria Hospital, Victoria, BC, Canada
| | | | | | | | | |
Collapse
|
13
|
|