Isoproterenol reduces ischemia-reperfusion lung injury despite beta-blockade

[Adrenergic mechanisms of regulation of pulmonary microvessels tonicity and endothelial permeability]

The review contains the data on adrenergic mechanisms of regulation of pulmonary microvessels tonicity and endothelial permeability. On smooth muscle cells of pulmonary vessels there are postsynaptic α1A-, α1B-, α1D- and α2A-, α2B-, α2C-adrenoreceptors whose activation by norepinephrine induces vasoconstriction. Excitation of β1- and β2-subtypes of adrenoreceptors leads to vasodilatation, Activation of α1-2- and β1-3-adrenoreceptors of the endothelium contributes to enhancement of nitric oxide synthesis. The resulting reaction of pulmonary microvessels in response to administration of catecholamines appears be determined by interaction of adrenergic mechanisms of regulation of tonicity of smooth muscle cells and synthesis of nitric oxide by the endothelium. Constrictor and dilator reactions of pulmonary venous vessels in response to activation of α- and β-adrenoreceptors, respectively, are more pronounced than in pulmonary arteries and make a significant contribution to the shifts of pulmonary vascular resistance. Excitation of α2- and β2-adrenoreceptors of endothelial cells of microvessels of the lungs contributes to a decrease in their permeability. In order to find out the role of adrenergic mechanisms in shifts of the capillary filtration coefficient in simulating various pathology of pulmonary circulation, it is necessary to carry out integral studies that would make it possible to evaluate alterations in macro- and microhaemodynamics of the lungs.

A reappraisal of isoproterenol in goal-directed therapy of septic shock

The goal of the study was to evaluate the effect of isoproterenol prescribed in goal-directed therapy for septic shock. Out of a cohort of 89 patients with septic shock, 14 patients treated with fluid and norepinephrine had inappropriate mixed venous oxygen saturation (SvO2<70%) not responding to correction of hypoxemia and anemia (>8 g.dL-1). Isoproterenol administration was started at a dose of 0.04 microg.kg-1.minute-1 with 0.025 microg.kg-1.minute-1 increments every 30 minutes until SvO2 was greater than 70%. Mean arterial pressure was maintained>or=65 mm.Hg by adjusting the norepinephrine infusion. Hemodynamic, oxygen, and renal variables were collected during a 12-h period. Patients with a known prior history of coronary disease were not eligible. Isoproterenol administration increased significantly SvO2 (62%+/-10% to 71%+/-9%), cardiac index (3.1+/-0.6 to 4.4+/-1.4 L.min-1.m-2), stroke index (27+/-3.4 to 38+/-6.1 mL.m-2), and left ventricular stroke work index (24+/-3.4 to 40+/-5.0 g.m-1.m-2). Heart rate rise did not reach a significant level. Arterial lactate concentration decreased significantly during the study period (5.7+/-2.8 to 3.4+/-1.6 mmol.L-1). No cardiac adverse events occurred with any electrocardiographic aspects of myocardial ischemia. This study suggests that isoproterenol is efficient to improve hemodynamics and oxygen variables in septic shock patients. There is a need for future investigations in larger groups of patients to determine whether isoproterenol can be an alternative to dobutamine.

Ex-vivo perfusion and ventilation of rat lungs from non-heart-beating donors before transplant

BACKGROUND

We developed an ex-vivo circuit to evaluate human lungs retrieved from non-heart-beating donors. We assessed the effect of a similar circuit on the function of transplanted rat lungs retrieved from non-heart-beating donors.

METHODS

One hour after death, Sprague-Dawley rat heart-lung blocks were flushed with 20 mL of cold Perfadex, stored cold for 1 hour, then warmed to 37 degrees C in a circuit perfused with Earle's crystalloid solution with or without washed porcine erythrocytes (hematocrit 12% to 15%). At 37 degrees C, lungs were ventilated for 15 minutes with alveolar gas, perfusion-cooled to 20 degrees C, flushed again with cold Perfadex, and then stored cold for 2.5 hours. The left lung was transplanted using a modified cuff technique with flow probes on the main and left pulmonary arteries. After 1 hour of reperfusion, arterial blood gases from the left pulmonary vein and wet/dry weight ratio (W/D) of both donor lungs were determined. Lungs transplanted after retrieval from heart-beating or non-heart-beating donors served as controls (n = 6 per group).

RESULTS

Lungs gained weight in the circuit but W/D and PO2 were similar after transplantation for all groups. After transplantation, vascular resistance was higher and dynamic compliance was lower for lungs perfused in the circuit. Myeloperoxidase and conjugated diene levels were modestly elevated in lungs transplanted from non-heart-beating donors irrespective of perfusion in the circuit.

CONCLUSIONS

Rat lungs are suitable for transplant after ex-vivo perfusion and ventilation. This model closely mimics methods used to evaluate the function of lungs retrieved from human non-heart-beating donors and can economically evaluate ex-vivo therapies for lungs retrieved from non-heart-beating donors.