Abstract:High central venous pressure (CVP) acutely decreases venous return. How this affects hepatic oxygen transport in sepsis remains unclear. The aim of this study was to evaluate the effects of repeated increases of CVP via standard nursing procedures (NPs) on hepato-splanchnic and renal oxygen transport in a prolonged porcine sepsis model. Twenty anesthetized and mechanically ventilated pigs with regional hemodynamics monitored were randomized to fecal peritonitis or controls (n=10 / group). Resuscitation was sta… Show more
“…1 . The experimental model is consolidated and known to produce systemic inflammation and organ failure 5 . Figure 1 Diagram of study protocol.…”
Section: Resultsmentioning
confidence: 99%
“…The clinical data are reported in the Supplemental Material (Fig. S1 , Table S3 ) for readers’ convenience as they were already published 5 . Briefly, after induction of fecal peritonitis, before resuscitation animals had low cardiac output and blood pressure.…”
Section: Resultsmentioning
confidence: 99%
“…Resuscitation then produced the typical hyperdynamic state with increased temperature, heart rate and cardiac output (CO). Septic animals received more Ringer’s lactate, norepinephrine and glucose to maintain hemodynamic stability and homeostasis, but at the same time, had lower urine output and higher positive fluid balance than sham pigs 5 . At T2/T3, platelets and leucocytes concentration were lower in septic than in sham animals, but band neutrophils percentage remained significantly higher in the septic group until the end of the experiment, although decreasing from T2 to T5 (Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The animal study was conducted according to the EU Directive 2010/63/EU for animal experiments and the ARRIVE guidelines for animal research, and was approved by the Animal Care Committee of the Canton of Bern, Switzerland (BE103/16). Details of the animals, anesthesia, instrumentation and experimental protocol were previously reported 5 .…”
Section: Methodsmentioning
confidence: 99%
“…Then, with the pigs in dorsal recumbency, a midline neck incision was made to allow placement of an arterial catheter (5F, Cordis AVANTI, Fremont, CA, USA) in the left carotid artery, a pulmonary artery catheter (8F, Edwards Lifesciences, Irvine, USA) via left external jugular vein, a venous catheter in the left internal jugular vein (5F, Cordis AVANTI, Fremont, CA, USA) for volume infusion, a triple-lumen catheter (7F, Arrow international, Inc, PA, USA) in the right internal jugular vein, and a flow probe (Transonic Systems Inc., Ithaca, NY, USA) around the right carotid artery to measure blood pressures, O 2 saturation and flow. The pig was then turned into a left lateral position and craniotomy was performed to place a single-lumen oximetry catheter (4F, Edwards Lifesciences, Irvine, USA) in the superior sagittal sinus together with a pressure probe (Probe 3PS, Spiegelberg GmbH & Co. KG, Hamburg, Germany) to measure sagittal sinus and intracranial pressures, used for a separate study 5 . After midline laparotomy in dorsal recumbency, a catheter was inserted into the urinary bladder for drainage and measurement of urine output.…”
We measured plasma and cerebrospinal fluid (CSF) metabolite concentrations in a 5-day porcine sepsis model of fecal peritonitis. The objectives were: (i) to verify whether the expected pathways that had emerged in previous studies pertain only to the early inflammatory response or persist for the subsequent days; (ii) to identify metabolic derangements that arise later; (iii) to verify whether CSF metabolite concentrations were altered and if these alterations were similar to those in the blood or delayed. We observed an early response to inflammation and cytokine storms with alterations in lipid and glucose metabolism. The arginine/asymmetric dimethylarginine (ADMA) and phenylalanine/tyrosine balances changed 24 h after resuscitation in plasma, and later in CSF. There was a rise in ammonia concentration, with altered concentrations of metabolites in the urea cycle. Whether persistent derangement of these pathways have a role not only on short-term outcomes but also on longer-term comorbidities, such as septic encephalopathy, should be addressed in further studies.
“…1 . The experimental model is consolidated and known to produce systemic inflammation and organ failure 5 . Figure 1 Diagram of study protocol.…”
Section: Resultsmentioning
confidence: 99%
“…The clinical data are reported in the Supplemental Material (Fig. S1 , Table S3 ) for readers’ convenience as they were already published 5 . Briefly, after induction of fecal peritonitis, before resuscitation animals had low cardiac output and blood pressure.…”
Section: Resultsmentioning
confidence: 99%
“…Resuscitation then produced the typical hyperdynamic state with increased temperature, heart rate and cardiac output (CO). Septic animals received more Ringer’s lactate, norepinephrine and glucose to maintain hemodynamic stability and homeostasis, but at the same time, had lower urine output and higher positive fluid balance than sham pigs 5 . At T2/T3, platelets and leucocytes concentration were lower in septic than in sham animals, but band neutrophils percentage remained significantly higher in the septic group until the end of the experiment, although decreasing from T2 to T5 (Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The animal study was conducted according to the EU Directive 2010/63/EU for animal experiments and the ARRIVE guidelines for animal research, and was approved by the Animal Care Committee of the Canton of Bern, Switzerland (BE103/16). Details of the animals, anesthesia, instrumentation and experimental protocol were previously reported 5 .…”
Section: Methodsmentioning
confidence: 99%
“…Then, with the pigs in dorsal recumbency, a midline neck incision was made to allow placement of an arterial catheter (5F, Cordis AVANTI, Fremont, CA, USA) in the left carotid artery, a pulmonary artery catheter (8F, Edwards Lifesciences, Irvine, USA) via left external jugular vein, a venous catheter in the left internal jugular vein (5F, Cordis AVANTI, Fremont, CA, USA) for volume infusion, a triple-lumen catheter (7F, Arrow international, Inc, PA, USA) in the right internal jugular vein, and a flow probe (Transonic Systems Inc., Ithaca, NY, USA) around the right carotid artery to measure blood pressures, O 2 saturation and flow. The pig was then turned into a left lateral position and craniotomy was performed to place a single-lumen oximetry catheter (4F, Edwards Lifesciences, Irvine, USA) in the superior sagittal sinus together with a pressure probe (Probe 3PS, Spiegelberg GmbH & Co. KG, Hamburg, Germany) to measure sagittal sinus and intracranial pressures, used for a separate study 5 . After midline laparotomy in dorsal recumbency, a catheter was inserted into the urinary bladder for drainage and measurement of urine output.…”
We measured plasma and cerebrospinal fluid (CSF) metabolite concentrations in a 5-day porcine sepsis model of fecal peritonitis. The objectives were: (i) to verify whether the expected pathways that had emerged in previous studies pertain only to the early inflammatory response or persist for the subsequent days; (ii) to identify metabolic derangements that arise later; (iii) to verify whether CSF metabolite concentrations were altered and if these alterations were similar to those in the blood or delayed. We observed an early response to inflammation and cytokine storms with alterations in lipid and glucose metabolism. The arginine/asymmetric dimethylarginine (ADMA) and phenylalanine/tyrosine balances changed 24 h after resuscitation in plasma, and later in CSF. There was a rise in ammonia concentration, with altered concentrations of metabolites in the urea cycle. Whether persistent derangement of these pathways have a role not only on short-term outcomes but also on longer-term comorbidities, such as septic encephalopathy, should be addressed in further studies.
Autonomic and vascular failures are common phenotypes of sepsis, typically characterized by tachycardia despite corrected hypotension/hypovolemia, vasopressor resistance, increased arterial stiffness and decreased peripheral vascular resistance. In a 5-day swine experiment of polymicrobial sepsis we aimed at characterizing arterial properties and autonomic mechanisms responsible for cardiovascular homeostasis regulation, with the final goal to verify whether the resuscitation therapy in agreement with standard guidelines was successful in restoring a physiological condition of hemodynamic profile, cardiovascular interactions and autonomic control. Twenty pigs were randomized to polymicrobial sepsis and protocol-based resuscitation or to prolonged mechanical ventilation and sedation without sepsis. The animals were studied at baseline, after sepsis development, and every 24 h during the 3-days resuscitation period. Beat-to-beat carotid blood pressure (BP), carotid blood flow, and central venous pressure were continuously recorded. The two-element Windkessel model was adopted to study carotid arterial compliance, systemic vascular resistance and characteristic time constant τ. Effective arterial elastance was calculated as a simple estimate of total arterial load. Cardiac baroreflex sensitivity (BRS) and low frequency (LF) spectral power of diastolic BP were computed to assess autonomic activity. Sepsis induced significant vascular and autonomic alterations, manifested as increased arterial stiffness, decreased vascular resistance and τ constant, reduced BRS and LF power, higher arterial afterload and elevated heart rate in septic pigs compared to sham animals. This compromised condition was persistent until the end of the experiment, despite achievement of recommended resuscitation goals by administered vasopressors and fluids. Vascular and autonomic alterations persist 3 days after goal-directed resuscitation in a clinically relevant sepsis model. We hypothesize that the addition of these variables to standard clinical markers may better profile patients’ response to treatment and this could drive a more tailored therapy which could have a potential impact on long-term outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
