Effect of Continuous Arteriovenous Hemofiltration Combined with Systemic Vasopressor Therapy on Depressed Left Ventricular Contractility and Tissue Oxygen Delivery in Canine Escherichia coli Sepsis

Mink, Steven N.; Jha, Praveen; Wang, R.; Yang, Juan; Böse, Dirk; Jacobs, Hans; Light, R. Bruce

doi:10.1097/00000542-199507000-00021

Cited by 30 publications

(6 citation statements)

References 16 publications

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“…The possibilities for the lack of hemodynamic improvement despite removal of FCS activity from plasma could be related to a number of factors. Since we previously showed that myocardial depression in sepsis could be acutely reversed by CAVH [4,13], the binding of the FCS to the myocardial cell must be somewhat reversible. However, the time course of events that occurs once FCS is bound to the myocardial cell is not clear.…”

Section: Discussionmentioning

confidence: 99%

“…In those groups in which hemofiltration was performed, the right femoral artery and vein were cannulated with polyethylene catheters for connection to a hemofilter (Gambro, CAVH Kit FH66, Hechingen, Germany) [4,13]. The hemofilter permits all solutes up to a molecular mass of approximately 30 000 Da to be removed from the plasma.…”

Section: Animal Preparation and Hemodynamic Measurementsmentioning

confidence: 99%

“…The animal's core temperature was maintained at 37 C by a warming blanket as needed. Moreover, since progressive metabolic acidosis develops in this pneumonia model [4,13], the ventilator rate was adjusted as needed throughout the experiment to maintain pH » 7.25 to 7.35. We preferred to increase the ventilator rate rather than to give sodium bicarbonate, since there are reports that sodium bicarbonate may worsen cardiac function in metabolic acidosis [14].…”

Section: Animal Preparation and Hemodynamic Measurementsmentioning

confidence: 99%

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Early but not delayed continuous arteriovenous hemofiltration improves cardiovascular function in sepsis in dogs

Mink

Böse

et al. 1999

Intensive Care Med

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Section: Discussionmentioning

confidence: 99%

Section: Animal Preparation and Hemodynamic Measurementsmentioning

confidence: 99%

Section: Animal Preparation and Hemodynamic Measurementsmentioning

confidence: 99%

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Early but not delayed continuous arteriovenous hemofiltration improves cardiovascular function in sepsis in dogs

Mink

Böse

et al. 1999

Intensive Care Med

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“…This effect on cardiac function was demonstrated once again by Mink et al and the effect attributed to the removal of circulating substances with a molecular weight of less than 30,000 Da. [58] These results have been repeatedly proven in subsequent studies [59] that confi rmed the elimination of different molecules. [60][61][62][63][64] Yekebas et al [64][65][66] in a series of experiments based in a model of pancreatitis in pigs allocated subjects to different levels of intensity of hemofi ltration plus adsorption and were able to demonstrate an improvement in serum cytokine levels, sepsis-related down-regulation of major histocompatibility complex II and CD14 expression on leukocytes, bacterial translocation, and endotoxemia related to the increasing intensity of the treatment provided.…”

Section: Clearance Of Infl Ammatory Mediators and Immunomodulationmentioning

confidence: 66%

Hemodynamic improvement after continuous renal replacement therapies: Not only immunomodulation

Herrera-Gutiérrez¹,

Seller-Pérez²,

Arias-Verdú³

et al. 2014

Journal of Translational Internal Medicine

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Hemodynamically unstable patients under continuous renal replacement therapies (CRRT) frequently show an improvement in hemodynamic parameters and a reduction in vasopressor agents. Different mechanisms have been proposed to explain this effect. A high rate of fluid exchange between interstitial and intravascular compartments seems to contribute to the therapeutic effect of CRRT. Other mechanism that seems to play a role is cooling; a raise in BP and SVR will follow a moderate heat loss but this effect will be accompanied by a decrement in oxygen delivery that can be detrimental and, when the cooling is severe, a shock can theoretically be precipitated. Metabolic acidosis, usually present when RRT is started, is a proinflammatory stimulus and conditions vasopressor unresponsiveness; the efficient control provided by CRRT can explain in part a positive hemodynamic response. Ionized calcium may have a role based on a potential effect on cardiac function and has been used in some studies in high concentration but there are limited in vivo data supporting this effect. The role of sodium concentration as a factor influencing hemodynamic tolerance has been reported for IHD but for CRRT has not been studied so far. Clearance of cytokines is the central key factor proposed as a mechanism for hemodynamic improvement but we have conflicting data regarding elimination. The volume of fluid exchange involved is a critical factor in order to reach an effective clearance but at this point we lack a proven theory for the way CCRT works. In this review we aim to explore possible mechanisms involved in the hemodynamic effect of CRRT on critically ill unstable patients.

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“…After the shock condition, however, when the vasoactive agents were added in the gentisic septic group and the NE septic group, there were increases in afterload which led to increases in Pwp. While intravenous fluids could easily be given when the Pwp was low, we did not want to phlebotomize that animal if the Pwp rose, because hemodynamic instability often follows this procedure [ 33 ]. Overall, however, the changes in Pwp were relatively small (see Table 3 ), and moreover, we do not think these changes would affect the hemodynamic findings to a significant extent.…”

Section: Discussionmentioning

confidence: 99%

Gentisic acid sodium salt, a phenolic compound, is superior to norepinephrine in reversing cardiovascular collapse, hepatic mitochondrial dysfunction and lactic acidemia in Pseudomonas aeruginosa septic shock in dogs

Mink

Chowdhury

Gotés

et al. 2016

ICMx

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BackgroundThe development of lactic acidemia (LA) in septic shock (SS) is associated with an ominous prognosis. We previously showed that the mechanism of LA in SS may relate to impaired hepatic uptake of lactate, but the mechanism was not clear. Uptake of lactate by the liver occurs by a membrane-associated, pH-dependent, antiport system known as the monocarboxylate transporter. In the hepatocyte, lactate can then be metabolized by oxidative phosphorylation or converted to glucose in the cytosol. In the present study, we examined (1) whether hepatic mitochondrial dysfunction accounted for decreased uptake of lactate in a canine model of Pseudomonas aeruginosa SS, (2) whether norepinephrine (NE) treatment by increasing mean arterial pressure (MAP) could improve mitochondrial dysfunction and LA in this model, and (3) whether gentisic acid sodium salt (GSS), a novel phenolic compound, was superior to NE in these effects.MethodsIn anesthetized/ventilated dogs, we infused the bacteria over ~10 h and measured hemodynamics in various treatment groups (see below). We then euthanized the animal and isolated the hepatic mitochondria. We measured hepatic mitochondrial oxygen consumption rates using the novel Seahorse XF24 analyzer under conditions that included: basal respiration, after the addition of adenosine- diphosphate to produce coupled respiration, and after the addition of a protonophore to produce maximal respiration.ResultsWe found that in the septic control group, mean arterial pressure decreased over the course of the study, and that mitochondrial dysfunction developed in which there was a reduction in maximal respiration. Whereas both NE and GSS treatments reversed the reduction in mean arterial pressure and increased maximal respiration to similar extents in respective groups, only in the GSS group was there a reduction in LA.ConclusionsHepatic mitochondrial dysfunction occurs in SS, but does not appear to be required for the development of LA in SS, since NE improved mitochondrial dysfunction without reversing LA. GSS, a phenolic compound restored mean arterial pressure, mitochondrial dysfunction, and LA in SS. This reduction in LA may be independent of its effect on improving hepatic mitochondrial function.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0095-0) contains supplementary material, which is available to authorized users.

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Effect of Continuous Arteriovenous Hemofiltration Combined with Systemic Vasopressor Therapy on Depressed Left Ventricular Contractility and Tissue Oxygen Delivery in Canine Escherichia coli Sepsis

Abstract: Our study offers a rationale for the combined use of phenylephrine and CAVH in the reversal of cardiac depression and hypotension in sepsis.

Cited by 30 publications

References 16 publications

Early but not delayed continuous arteriovenous hemofiltration improves cardiovascular function in sepsis in dogs

Early but not delayed continuous arteriovenous hemofiltration improves cardiovascular function in sepsis in dogs

Hemodynamic improvement after continuous renal replacement therapies: Not only immunomodulation

Gentisic acid sodium salt, a phenolic compound, is superior to norepinephrine in reversing cardiovascular collapse, hepatic mitochondrial dysfunction and lactic acidemia in Pseudomonas aeruginosa septic shock in dogs

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