A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion (Lactic Acidemia) in Patients with Septic Shock

Nitric oxide-dependent and -independent mechanisms are involved in TNF-α-induced depression of cardiac myocyte contractility

“…However, this study was performed to better understand septic myocardial depression. In this context, we have already shown a significant relationship between septic serum-induced in vitro cardiac depression in this model and in vivo cardiac depression (decreased ejection fraction) in the septic shock patients from whom the serum is obtained (21,27,31). To the extent that TNF-␣ is a central component of septic serum-induced myocyte depression (21), our current findings provide insight into the pathophysiological mechanisms that may underlie septic myocardial depression.…”

“…Measurements of isolated cardiac myocyte contraction in the presence of serum from patients with acute septic shock demonstrate a depression of maximum extent and peak velocity of myocyte shortening that correlates quantitatively and temporally with depression of the patient's left ventricular ejection fraction as measured by radionuclide ventriculography (27,31). We have demonstrated that this depressant activity represents a synergistic combination of low-circulating concentrations of the proinflammatory cytokines TNF-␣ and IL-1␤ (21).…”

“…sepsis; septic shock; adrenoreceptor; myocardial depression; myocyte; heart; myocardial depressant substance; cytokine THE NORMAL CARDIAC RESPONSE to septic shock involves biventricular dilatation and decreased ejection fractions (14,24,25). Clinically, septic myocardial depression is also reflected by a suboptimal stroke volume response to fluid resuscitation (22) and infusion of exogenous catecholamines (15,20,32).The causal role of circulating factors in myocardial depression in human septic shock is now well established (21,(27)(28)(29)31). Measurements of isolated cardiac myocyte contraction in the presence of serum from patients with acute septic shock demonstrate a depression of maximum extent and peak velocity of myocyte shortening that correlates quantitatively and temporally with depression of the patient's left ventricular ejection fraction as measured by radionuclide ventriculography (27,31).…”

“…The causal role of circulating factors in myocardial depression in human septic shock is now well established (21,(27)(28)(29)31). Measurements of isolated cardiac myocyte contraction in the presence of serum from patients with acute septic shock demonstrate a depression of maximum extent and peak velocity of myocyte shortening that correlates quantitatively and temporally with depression of the patient's left ventricular ejection fraction as measured by radionuclide ventriculography (27,31).…”

Effect of Severity Disease on the Pharmacokinetics of Cefuroxime in Children with Multiple Organ System Failure

“…Intraindividual variations due to sepsis 16,17) and mechanical ventilation 18,19) have been recently described although not extensively evaluated. Changes in cardiac output, renal and hepatic function, 20) and circulating serum proteins, commonly seen in critically ill septic patients, 16,21) can alter the rate of drug elimination and consequently its plasma levels. It is widely accepted that many patients with sepsis show extravascular fluid sequestrations, resulting in substantial intravascular volume depletion.…”