Hemodynamic studies and results of therapy in 50 patients with bacteremic shock

Winslow, Edward; Loeb, Henry S.; Rahimtoola, Shahbudin H.; Kamath, Savitri K.; Gunnar, Rolf M.

doi:10.1016/0002-9343(73)90038-7

Cited by 225 publications

(58 citation statements)

References 28 publications

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“…(2) In three patients with acute renal failure who required immediate hemodialysis, arterial lactate concentration fell after dialysis, whereas myocardial lactate and free fatty acid uptake remained unchanged. In addition, similar alterations in substrate were observed by Spitzer" under conditions in vitro using enzymatically isolated beating adult myocytes incubated in the presence of increasing concentration of Escherichia coli endotoxin.…”

Section: Discussionmentioning

confidence: 95%

Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock.

Dhainaut¹,

Huyghebaert²,

Monsallier³

et al. 1987

Circulation

336

122

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To investigate disturbances in the coronary circulation and myocardial metabolism during septic shock, we examined coronary sinus blood flow and myocardial substrate extraction in 40 patients with septic shock and 13 control patients. Patients with coronary artery disease were excluded from this study. The global hemodynamic pattern of the septic patients was characterized by a lower stroke volume, despite an elevated cardiac index. Coronary sinus blood flow was high (187 + 47 vs 130 ± 21 ml/min in the control group, p < .001) due to marked coronary vasodilation, especially in the subgroup of nonsurvivors. In contrast to the control group, myocardial lactate uptake was elevated, while that of free fatty acids, glucose, and ketone bodies was diminished in patients with septic shock. These findings were especially prominent in the nonsurvivors. Expressed as oxygen equivalents, the contribution of free fatty acids as an energy source of the myocardium was markedly diminished in septic patients (12% vs 54% in the control group, p < .005), while that of lactate was increased (36% vs 12%, p < .01). The observed shift in myocardial substrate extraction was associated with a discrepancy between measured myocardial oxygen consumption and that calculated chemically from commonly available exogenous substrates: 41 % of myocardial oxygen consumption was not explained by the utilization of commonly available substrates extracted from coronary circulation in all patients with septic shock. These data indicate that myocardial utilization of endogenous substrates may probably account for this discrepancy, suggesting that a "mandatory" utilization of endogenous energy sources might underlie progressive cardiac involvement in septic shock. Circulation 75, No. 3, 533-541, 1987. SEPTIC SHOCK is a frequent and serious disorder with a high mortality. In recent years, increasing attention has been directed to the study of the hemodynamic and metabolic alterations accompanying septic shock.

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Section: Discussionmentioning

confidence: 95%

Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock.

Dhainaut¹,

Huyghebaert²,

Monsallier³

et al. 1987

Circulation

336

122

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show abstract

“…'4 The high flow, low vascular resistance, and narrowed oxygen content difference in the coronary circulation in patients with septic shock are analogous to the high cardiac output, low systemic vascular resistance, and narrowed arteriovenous oxygen content difference characteristic of peripheral shunting in the systemic circulation in septic shock." 21 Thus, in septic shock, coronary blood flow is not autoregulated normally, that is, it is not determined purely by myocardial oxygen need.…”

Section: Discussionmentioning

confidence: 99%

The coronary circulation in human septic shock.

Cunnion

Schaer²,

Parker³

et al. 1986

Circulation

417

134

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Reversible myocardial depression, manifested by ventricular dilatation and decreased ejection fraction, is common in human septic shock. A proposed mechanism, based on animal studies, is myocardial ischemia resulting from inadequate coronary blood flow. Coronary flow observations have not been reported for human septic shock. To determine whether myocardial depression in human septic shock is associated with reduced coronary flow, thermodilution coronary sinus catheters were placed in seven patients with septic shock for measurements of coronary flow and myocardial metabolism. Four of the seven patients developed myocardial depression. These patients had coronary flow similar to or higher than that of control subjects and similar to that of the other three patients, who did not develop myocardial depression. None of the patients had net myocardial lactate production. In general, compared with values in control subjects, the oxygen content difference (arterial minus coronary sinus) was narrowed, and the fractional extraction of arterial oxygen was diminished. This pattern of disordered coronary autoregulation is analogous to the pattern of arteriovenous shunting in other organs in patients with septic shock. The preservation of coronary flow, the net myocardial lactate extraction, and the increased availability of oxygen to the myocardium argue against global ischemia as the cause of myocardial depression in human septic shock. Circulation 73, No. 4, 637-644, 1986. MYOCARDIAL DEPRESSION within the first several days of human septic shock is characterized by dilatation of the left ventricle, a decrease in left ventricular ejection fraction, and maintenance of normal or increased cardiac index. 1 2 In survivors, these profound changes in ventricular function are transient and the ejection fraction generally returns to normal in 7 to 10 days.' The pathogenesis of myocardial depression in septic shock is unclear, but in canine preparations of endotoxic shock myocardial depression has been attributed to myocardial hypoperfusion caused by reduced coronary blood flow.3-7Human coronary blood flow has been studied extensively in normal subjects and in patients with coronary artery disease, by means of nitrous oxide washout, inert gas washout, and thermodilution techniques. The determinants of myocardial lactate metabolism and myocardial oxygen consumption have been characterized. Measurements dial lactate metabolism, and myocardial oxygen consumption have been reported in cardiogenict but not in septic shock in human beings. The current study was undertaken to determine whether myocardial depression in human septic shock is associated with changes in coronary blood flow and whether such changes could explain the depressed cardiac function. MethodsPatients. From October 1982 to February 1984, seven patients with septic shock were studied in the Medical Intensive Care Unit of the National Institutes of Health. The diagnosis of septic shock was based on hypotension (mean arterial pressure less than 60 mm Hg), t...

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“…Poucos estudos avaliaram o uso do isoproterenol na sepse e choque séptico. Embora promova elevações significativas do DC, pode provocar hipotensão e taquicardia resultando em isquemia cardíaca 60 (B) 61 (C). O levosimendan é um sensibilizador de cálcio favorecendo o acoplamento actina-miosina e melhora a contratilidade cardíaca sem elevar o consumo de oxigênio do miócito.…”

Section: Existe Um Inotrópico Ideal Para Ser Utilizado No Paciente Séunclassified

Sepse: ressuscitação hemodinâmica

2010

Rev. Assoc. Med. Bras.

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Hemodynamic studies and results of therapy in 50 patients with bacteremic shock

Cited by 225 publications

References 28 publications

Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock.

Coronary hemodynamics and myocardial metabolism of lactate, free fatty acids, glucose, and ketones in patients with septic shock.

The coronary circulation in human septic shock.

Sepse: ressuscitação hemodinâmica

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