Efficient Extra- and Intracellular Alkalinization Improves Cardiovascular Functions in Severe Lactic Acidosis Induced by Hemorrhagic Shock

Abstract

The current study looked at the levels of MMP-8 and TIMP-1 in blood samples from a large cohort of patients with ARF. The investigators tried to show whether increases in either the levels of these proteins or their ratio are associated with increased mortality. Of 563 patients, only 43 had ARDS, and therefore, the information collected from the study did not reach statistical significance concerning patients with ARDS specifically. However, the investigators found that higher blood levels of TIMP-1 immediately after admission were associated with higher mortality. Moreover, this was an independent risk factor for mortality after including other recognized risk factors, such as SAPS II and SOFA score, in the model.The investigators concluded that further studies are required in order to fully understand the predictive value of these markers. It would be interesting to assess their levels in local samples (tracheal aspirates, for example) and compare those to blood levels. However, as with all other biomarkers, the large SD in the levels as well as the rapidly changing time course place the clinical usefulness of such tests in question.

Lactic Acidosis: Current Treatments and Future Directions

“…Hyperventilation to reduce carbon dioxide accumulation and infusion of calcium to stabilize calcium concentration increased intracellular pH and blood pH, improved myocardial function, and reduced the quantity of vasopressors necessary to maintain blood pressure in rats with hemorrhage-induced lactic acidosis administered bicarbonate. 16,27 When base is given, the clinician should try to maintain blood pH at w7.2. This pH was chosen because lower values depressed cardiac contractility in animals, 28 suppressed the contraction of myocardial fibrils isolated from failing hearts of humans, 27 and was associated with increased mortality.…”

“…8 Increasing blood pH to w7.2 should improve cardiac contractility and restore responsiveness of the myocardium and peripheral vessels to endogenous and infused catecholamines. 16,29,30 To calculate the quantity of bicarbonate required to increase serum bicarbonate concentration to a given amount, we assume that administered bicarbonate is distributed in 50% body weight expressed in kilograms (bicarbonate space). This is only an estimate, and monitoring of acid-base parameters every few hours is required for potential dose adjustment.…”

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock

“…To avoid any interference with the adrenergic system, catecholamines were not administered in this study. In this model, all animals that underwent CLP displayed the typical pattern of septic shock, including hypotension, low cardiac output, hyperlactatemia and vascular hyporesponsiveness to catecholamines, as in our previous study [14,18]. Moreover, low concentrations of isoflurane were deliberately used to minimize the impact of anesthesia on cardiac and vascular functions [19].…”

Predictors of Prolonged Mechanical Ventilation in Adults After Acute Type-A Aortic Dissection Repair—Implications for the Future

“…Results from a porcine model provided a possible explanation in that administration of sodium bicarbonate during shock resulted in intracellular acidosis and decreased cardiovascular function compared to sodium bicarbonate accompanied by calcium administration and hyperventilation. 15 Thus, a marker indicative of intracellular pH and oxygen consumption, such as tricarboxylic acid cycle intermediates, may better reflect tissue oxygen delivery. Succinate is a tricarboxylic acid cycle intermediate that accumulates in plasma during shock due to failure of forward flow of the electron transport chain in mitochondria.…”