Effects of a Dobutamine-induced Increase in Splanchnic Blood Flow on Hepatic Metabolic Activity in Patients with Septic Shock

Reinelt, Helmut; Radermacher, Peter; Fischer, G.; Geisser, W.; Wachter, Ulrich; Wiedeck, H; Georgieff, Michael; Vogt, J.

doi:10.1097/00000542-199704000-00012

Cited by 119 publications

(54 citation statements)

References 25 publications

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“…Although cardiac output is usually maintained in volume-resuscitated septic patients, a number of investigators (Parrillo et al, 1990;Holcroft et al, 2001;Parker et al, 1984Parker et al, , 1990) have demonstrated impairment of cardiac function. This myocardial dysfunction is characterized by decreased ejection fraction, ventricular dilation, impaired contractile response to volume loading, and a low peak systolic pressure to end-systolic volume ratio, a load-independent measure of ventricular function (Holcroft et al, 2001;Schaer et al, 1985;Reinelt et al, 1997). Chronic peritoneal sepsis in our model produces a prolonged hyperdynamic stage of sepsis and has clinical relevance (Sam II et al, 1997).…”

Section: Discussionmentioning

confidence: 98%

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Chopra

Sharma

2007

Life Sciences

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We hypothesized that progressive decline in myocardial performance would correlate with upregulation of markers for apoptotic mechanisms following increased duration of polymicrobial sepsis in the rat. Male Sprague-Dawley rats (350-400 g) were randomized into sham, 1-, 3-and 7-day sepsis groups. Each septic rat received 200 mg/kg cecal inoculum intraperitoneally (i.p). The post-mortem analysis showed a severely inflamed peritoneum with the presence of pus in all septic animals that was directly proportional to the duration of sepsis. We observed 10, 33 and 42% mortality in the 1-, 3-and 7-day sepsis groups, respectively. Septic animals at 3 and 7 days exhibited an increased wet lung/total body weight and heart weight/total body weight. A significant increase in total cardiac troponin I (cTnI) and C Reactive Protein (CRP) and endothelin-1 (ET-1) was also observed with an increased duration of sepsis. Myocardial ET-1 concentration in the 7-day postsepsis group was significantly elevated compared to the sham and 1-day post-sepsis groups. Sepsis also produced a significant decrease in the mean arterial pressure in the 7-day post-sepsis group and tachycardia in the 1-, 3-, and 7-day post-sepsis groups compared to the sham group. A significant prolongation of the left ventricular isovolumic relaxation rate constant, tau, and left ventricular enddiastolic pressure in the 1-, 3-and 7-day post-sepsis groups compared to the sham group was observed. In addition, a significant decrease in the rates of left ventricular relaxation (−dP/dt) and contraction (+dP/dt) in the 3-and 7-day post-sepsis groups compared to the sham and 1-day postsepsis group was observed. Sepsis produced a significant upregulation in the expression of myocardial TRADD, cytosolic active caspase-3, the Bax/Bcl 2 ratio, and the mitochondrial release of cytochrome C in the 3-and 7-day post-sepsis groups. We observed a progressive increase in the number of TUNEL positive nuclei, cytosolic caspase-3 activation and co-localization of PARP in the nuclei at 1, 3 and 7 days post-sepsis. These data suggest that the progression of sepsis from 1 day to 3-7 days produce distinct cardiodynamic characteristics with a more profound effect during later stages. The sepsis-induced decline in myocardial performance correlates with the induction of myocardial apoptosis.

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Section: Discussionmentioning

confidence: 98%

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Chopra

Sharma

2007

Life Sciences

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“…Addition of dobutamine to NE in septic patients revealed a lower pCO 2 g-a , but no change in ICG plasma clearance [68,69]; this could either be due to a direct effect on the microcirculation or a result of an increase in cardiac output. Whether an increase in general splanchnic perfusion indeed is followed by improved organ function is still a matter of debate [70]. Dopamine (b 2 -adrenergic and dopaminergic, Table 4; in high-dose also a-adrenergic, Table 2) was used in sepsis for many years in low concentrations for its potential beneficial effects on renal function as a result of afferent renal vessel dilatation.…”

Section: Vasopressorsmentioning

confidence: 99%

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Boerma

İnce

2012

Applied Physiology in Intensive Care Medicine 2

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“…In combination with norepinephrine, dobutamine is used in septic shock with myocardial dysfunction. In septic shock, dobutamine also increases splanchnic blood flow and oxygen delivery and decreased endogenous glucose production (15). As with all catecholamines with a ␤-adrenergic effect, dobutamine may cause a mismatch of myocardial oxygen delivery and requirement.…”

Section: Dobutaminementioning

confidence: 99%

Approach to Hemodynamic Shock and Vasopressors

Herget–Rosenthal¹,

Saner²,

Chawla³

2008

Clinical Journal of the American Society of Nephrology

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H emodynamic shock (HS) is a clinical syndrome that is commonly observed in hospitalized patients. Prompt recognition and intervention are the cornerstones of mitigating the dire consequences of HS. Untreated HS usually leads to death. Unlike other types of clinical syndromes (e.g., chest pain), for which a clinical diagnosis is made before treatment is initiated in earnest, the treatment of shock often occurs concurrently or ahead of the diagnostic process. The maintenance of end-organ perfusion is critical to prevent irreversible organ injury and failure, and this frequently requires the use of fluid resuscitation and vasopressors. A complete review of all of the signs and symptoms, diagnosis, and treatment of HS has been reviewed in detail elsewhere (1). This article provides a concise summary of how to approach the patient in HS, diagnostic and therapeutic decision making, and the use of vasopressors. In addition, the effects of vasopressors on end organs with particular focus on renal hemodynamics is reviewed. Clinical Manifestations and Recognition of Hemodynamic ShockHS is classically described as "an acute clinical syndrome initiated by ineffective perfusion, resulting in severe dysfunction of organs vital to survival" (1). As clinicians, we take great pains to teach our trainees that shock is not just hypotension, but that shock represents hypoperfusion of end organs. This rationale leads to the common refrain: "Normotensive patients can often suffer from shock." The clinical manifestations of HS are related directly to the end organs that are not receiving adequate perfusion and can be categorized on the basis of the organ affected. Besides hypotension, the classic signs and symptoms of HS are tachycardia, relative hypotension (a decrease in baseline BP of 40 mmHg), tachypnea, cool and clammy extremities, oliguria, dysglycemia, and delirium (1). Patients who are hypotensive (systolic BP Ͻ90 mmHg in patients whose baseline BP is usually low) but show no signs or symptoms of shock should have their BP rechecked. An indwelling arterial catheter or Doppler may be necessary to resolve a false low BP reading (1). In the absence of hypotension, the diagnosis of HS can be more challenging and will require the clinician to increase his or her scrutiny of the patient and either rule in or rule out HS with further clinical investigations. For patients who are normotensive, the measurement of serum lactate will often reveal the presence of HS in a patient whose clinical evaluation is equivocal. This entity of a normotensive patient with some clinical signs of HS with an elevated lactate is often referred to as "cryptic shock." In this condition, the patient is not yet in critical condition but cannot meet their body's oxygen demand, resulting in evidence of significant anaerobic metabolism. Previous trials showed that presence of HS and a serum lactate concentration of Ͼ4.0 mmol/L are associated with a mortality of 30 to 45% (2).Once HS is recognized, interventions to restore tissue perfusion are mandatory. Three ...

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Effects of a Dobutamine-induced Increase in Splanchnic Blood Flow on Hepatic Metabolic Activity in Patients with Septic Shock

Cited by 119 publications

References 25 publications

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

Distinct cardiodynamic and molecular characteristics during early and late stages of sepsis-induced myocardial dysfunction

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Approach to Hemodynamic Shock and Vasopressors

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