Comparison of cardiac, hepatic, and renal effects of arginine vasopressin and noradrenaline during porcine fecal peritonitis: a randomized controlled trialReportar como inadecuado




Comparison of cardiac, hepatic, and renal effects of arginine vasopressin and noradrenaline during porcine fecal peritonitis: a randomized controlled trial - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 13:R113

First Online: 10 July 2009Revised: 18 June 2009Accepted: 10 July 2009

Abstract

IntroductionInfusing arginine vasopressin AVP in vasodilatory shock usually decreases cardiac output and thus systemic oxygen transport. It is still a matter of debate whether this vasoconstriction impedes visceral organ blood flow and thereby causes organ dysfunction and injury. Therefore, we tested the hypothesis whether low-dose AVP is safe with respect to liver, kidney, and heart function and organ injury during resuscitated septic shock.

MethodsAfter intraperitoneal inoculation of autologous feces, 24 anesthetized, mechanically ventilated, and instrumented pigs were randomly assigned to noradrenaline alone increments of 0.05 μg-kg-min until maximal heart rate of 160 beats-min; n = 12 or AVP 1 to 5 ng-kg-min; supplemented by noradrenaline if the maximal AVP dosage failed to maintain mean blood pressure; n = 12 to treat sepsis-associated hypotension. Parameters of systemic and regional hemodynamics ultrasound flow probes on the portal vein and hepatic artery, oxygen transport, metabolism endogenous glucose production and whole body glucose oxidation derived from blood glucose isotope and expiratory CO2-CO2 enrichment during 1,2,3,4,5,6-C6-glucose infusion, visceral organ function blood transaminase activities, bilirubin and creatinine concentrations, creatinine clearance, fractional Na excretion, nitric oxide exhaled NO and blood nitrate + nitrite levels and cytokine production interleukin-6 and tumor necrosis factor-α blood levels, and myocardial function left ventricular dp-dtmax and dp-dtmin and injury troponin I blood levels were measured before and 12, 18, and 24 hours after peritonitis induction. Immediate post mortem liver and kidney biopsies were analysed for histomorphology hematoxylin eosin staining and apoptosis TUNEL staining.

ResultsAVP decreased heart rate and cardiac output without otherwise affecting heart function and significantly decreased troponin I blood levels. AVP increased the rate of direct, aerobic glucose oxidation and reduced hyperlactatemia, which coincided with less severe kidney dysfunction and liver injury, attenuated systemic inflammation, and decreased kidney tubular apoptosis.

ConclusionsDuring well-resuscitated septic shock low-dose AVP appears to be safe with respect to myocardial function and heart injury and reduces kidney and liver damage. It remains to be elucidated whether this is due to the treatment per se and-or to the decreased exogenous catecholamine requirements.

AbbreviationsALATalanine aminotransferase

ASATasparatate aminotransferase

AVParginine vasopressin

CO2carbon dioxide

dp-dtmaxmaximal systolic contraction

dp-dtminmaximal diastolic relaxation

FADH2reduced flavine adenine dinucleotide

FiO2fraction of inspired oxygen

HandEhematoxylin and eosin

I-Einspiratory-to-expiratory

IL-6interleukin-6

NADHreduced nicotineamide adenine dinucleotide

NO2+NO3nitrate+nitrite

O2oxygen

PaO2partial pressure of arterial oxygen

PaCO2partial pressure of arterial carbon dioxide

PEEPpositive end-expiratory pressure

τdiastolic relaxation time constant

TNFαtumor necrosis factor-α

TUNELterminal deoxynucleotidyltransferase-mediated nick-end labeling assay

VASSTvasopressin and septic shock trial.

Electronic supplementary materialThe online version of this article doi:10.1186-cc7959 contains supplementary material, which is available to authorized users.

Florian Simon, Ricardo Giudici, Angelika Scheuerle contributed equally to this work.

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Autor: Florian Simon - Ricardo Giudici - Angelika Scheuerle - Michael Gröger - Pierre Asfar - Josef A Vogt - Ulrich Wachter - Fr

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



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