Effects of early hemodynamic resuscitation on left ventricular performance and microcirculatory function during endotoxic shockReportar como inadecuado




Effects of early hemodynamic resuscitation on left ventricular performance and microcirculatory function during endotoxic shock - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Intensive Care Medicine Experimental

, 3:14

First Online: 08 May 2015Received: 09 December 2014Accepted: 15 March 2015

Abstract

BackgroundMicrocirculation and macrohemodynamics are severely compromised during septic shock. However, the relationship between these two compartments needs to be further investigated. We hypothesized that early resuscitation restores left ventricular LV performance and microcirculatory function but fails to prevent metabolic disorders. We studied the effects of an early resuscitation protocol ERP on LV pressure-volume loops-derived parameters, sublingual microcirculation, and metabolic alterations during endotoxic shock.

MethodsTwenty-five pigs were randomized into three groups: LPS group: Escherichia coli lipopolysaccharide LPS; ERP group: LPS + ERP based on volume expansion, dobutamine, and noradrenaline infusion; Sham group. LV pressure-volume-derived parameters, systemic hemodynamics, sublingual microcirculation, and metabolic profile were assessed at baseline and after completing the resuscitation protocol.

ResultsLPS significantly decreased LV end-diastolic volume, myocardial contractility, stroke work, and cardiac index CI. Early resuscitation preserved preload, and myocardial contractility, increased CI and heart rate p < .05. LPS severely diminished sublingual microvascular flow index MFI, perfused vascular density PVD, and the proportion of perfused vessels PPV, while increased the heterogeneity flow index HFI p < .05. Despite MFI was relatively preserved, MVD, PVD, and HFI were significantly impaired after resuscitation p < .05. The macro- and microcirculatory changes were associated with increased lactic acidosis and mixed venous O2 saturation when compared to baseline values p < .05. The scatter plot between mean arterial pressure MAP and MFI showed a biphasic relationship, suggesting that the values were within the limits of microvascular autoregulation when MAP was above 71 ± 6 mm Hg R = 0.63.

ConclusionsEarly hemodynamic resuscitation was effective to restore macrohemodynamia and myocardial contractility. Despite MAP and MFI were relatively preserved, the persistent microvascular dysfunction could explain metabolic disorders. The relationship between micro- and systemic hemodynamia and their impact on cellular function and metabolism needs to be further studied during endotoxic shock.

KeywordsEndotoxic shock Early hemodynamic resuscitation Microcirculation Video microscopy Left ventricular function AbbreviationsCOcardiac output

CIcardiac index

CVPcentral venous pressure

ERPearly resuscitation protocol

ERO2oxygen extraction ratio

HFIheterogeneity flow index

IDO2systemic O2 delivery index

IVO2.systemic O2 consumption index

LPSEscherichia coli endotoxin lipopolysaccharide

LVleft ventricle

LVEDVleft ventricular end-diastolic volume

MAPmean arterial pressure

MFImicrovascular flow index

MVDmicrovascular density

PAPpulmonary artery pressure

PAOPpulmonary arterial occlusion pressure

PRSWpreload recruitable stroke work

PPVproportion of perfused vessels

PVDperfused vascular density

SDFsidestream dark field

SvO2mixed venous oxygen saturation

SVRIsystemic vascular resistance index

SWstroke work.

Electronic supplementary materialThe online version of this article doi:10.1186-s40635-015-0049-y contains supplementary material, which is available to authorized users.

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Autor: Alejandra López - Juan Carlos Grignola - Martín Angulo - Ignacio Alvez - Nicolás Nin - Gonzalo Lacuesta - Manuel Baz -

Fuente: https://link.springer.com/







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