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Näslund E, Lindberg LG, Strandberg G, Apelthun C, Franzén S, Frithiof R. Oxygen saturation in intraosseous sternal blood measured by CO-oximetry and evaluated non-invasively during hypovolaemia and hypoxia - a porcine experimental study. J Clin Monit Comput 2023; 37:847-856. [PMID: 36786963 PMCID: PMC10175432 DOI: 10.1007/s10877-023-00980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE This study intended to determine, and non-invasively evaluate, sternal intraosseous oxygen saturation (SsO2) and study its variation during provoked hypoxia or hypovolaemia. Furthermore, the relation between SsO2 and arterial (SaO2) or mixed venous oxygen saturation (SvO2) was investigated. METHODS Sixteen anaesthetised male pigs underwent exsanguination to a mean arterial pressure of 50 mmHg. After resuscitation and stabilisation, hypoxia was induced with hypoxic gas mixtures (air/N2). Repeated blood samples from sternal intraosseous cannulation were compared to arterial and pulmonary artery blood samples. Reflection spectrophotometry measurements by a non-invasive sternal probe were performed continuously. RESULTS At baseline SaO2 was 97.0% (IQR 0.2), SsO2 73.2% (IQR 19.6) and SvO2 52.3% (IQR 12.4). During hypovolaemia, SsO2 and SvO2 decreased to 58.9% (IQR 16.9) and 38.1% (IQR 12.5), respectively, p < 0.05 for both, whereas SaO2 remained unaltered (p = 0.44). During hypoxia all saturations decreased; SaO2 71.5% (IQR 5.2), SsO2 39.0% (IQR 6.9) and SvO2 22.6% (IQR 11.4) (p < 0.01), respectively. For hypovolaemia, the sternal probe red/infrared absorption ratio (SQV) increased significantly from baseline (indicating a reduction in oxygen saturation) + 5.1% (IQR 7.4), p < 0.001 and for hypoxia + 19.9% (IQR 14.8), p = 0.001, respectively. CONCLUSION Sternal blood has an oxygen saturation suggesting a mixture of venous and arterial blood. Changes in SsO2 relate well with changes in SvO2 during hypovolaemia or hypoxia. Further studies on the feasibility of using non-invasive measurement of changes in SsO2 to estimate changes in SvO2 are warranted.
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Affiliation(s)
- Erik Näslund
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden. .,Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden. .,Department of Anaesthesia, Gävle Hospital, 801 87, Gävle, Sweden.
| | - Lars-Göran Lindberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Gunnar Strandberg
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Catharina Apelthun
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Stephanie Franzén
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
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Bomberg H, Bierbach B, Flache S, Novák M, Schäfers HJ, Menger MD. Dobutamine Versus Vasopressin After Mesenteric Ischemia. J Surg Res 2019; 235:410-423. [DOI: 10.1016/j.jss.2018.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/15/2018] [Accepted: 10/17/2018] [Indexed: 12/26/2022]
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Sergi C, Shen F, Lim DW, Liu W, Zhang M, Chiu B, Anand V, Sun Z. Cardiovascular dysfunction in sepsis at the dawn of emerging mediators. Biomed Pharmacother 2017; 95:153-160. [PMID: 28841455 DOI: 10.1016/j.biopha.2017.08.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/03/2017] [Accepted: 08/13/2017] [Indexed: 12/14/2022] Open
Abstract
Subcellular dysfunction and impaired metabolism derived from the complex interaction of cytokines and mediators with cellular involvement are on the basis of the cardiovascular response to sepsis. The lethal consequences of an infection are intimately related to its ability to spread to other organ sites and the immune system of the host. About one century ago, William Osler (1849-1919), a Canadian physician, remarkably defined the sequelae of the host response in sepsis: "except on few occasions, the patient appears to die from the body's response to infection rather than from it." Cardiac dysfunction has received considerable attention to explain the heart failure in patients progressing from infection to sepsis, but our understanding of the processes remains limited. In fact, most concepts are linked to a mechanical concept of the sarcomeric structure, and physiological data seems to be often disconnected. Cytokines, prostanoids, and nitric oxide release are high direct impact factors, but coronary circulation and cardiomyocyte physiology also play a prominent role in modulating the effects of monocyte adhesion and infiltration. Damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs) are involved in the host response. The identification of microRNAs, as well as the cyclic activation of the inflammatory cascade, has further added complexity to the scene. In this review, we delineate the current concepts of cellular dysfunction of the cardiomyocyte in the setting of sepsis and consider potential therapeutic strategies.
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Affiliation(s)
- Consolato Sergi
- Institute of Biomedical and Pharmaceutical Sciences, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei Provincial Cooperative Innovation Center of Industrial Fermentation, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, 430068, PR China; Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, PR China; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University Alberta Hospital, Edmonton, AB, Canada.
| | - Fan Shen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - David W Lim
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Weiyong Liu
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Mingyong Zhang
- Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, PR China
| | - Brian Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Vijay Anand
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Chen H, Wang W, Hong Y, Zhang H, Hong C, Liu X. Single-blinded, randomized, and controlled clinical trial evaluating the effects of Omega-3 fatty acids among septic patients with intestinal dysfunction: A pilot study. Exp Ther Med 2017; 14:1505-1511. [PMID: 28810616 PMCID: PMC5525580 DOI: 10.3892/etm.2017.4680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/20/2017] [Indexed: 11/25/2022] Open
Abstract
Sepsis is a systemic inflammatory reaction, which is aggravated by aspects of the immune response that are thought to be inhibited by Omega-3 fatty acids. The aim of the present study was to determine if Omega-3 fatty acid could modulate immunological function and improve survival rate among septic patients with intestinal dysfunction. A total of 48 mechanically ventilated patients with intestinal dysfunction were included in this prospective, randomized and single-blind clinical study. Patients were randomly divided into control (group A) and treatment groups (group B). The treatment protocol for all the participants followed the Sepsis Survival Campaign guidelines, and group B received total parenteral nutrition containing 100 ml of Omega-3 fatty acids (containing 10 g refined fish oil) per day in addition to the standard treatment applied in group A. Group B had a significantly lower mortality rate compared with group A (12.5 vs. 41.7%, P<0.05) during the 28-day follow-up. Group B also had lower Acute Physiology and Chronic Health Evaluation II scores (P<0.05) and lower Marshall scores (P<0.05) at day 7. In addition, group B had a higher ratio of T helper to inducer lymphocytes as well as a higher ratio of CD4 to CD8 lymphocytes (P<0.01 for both) than group A. It was concluded that Omega-3 fatty acids improved T helper/inducer and CD4/CD8 ratios, and may have reduced mortality, among septic patients with intestinal dysfunction.
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Affiliation(s)
- Huaisheng Chen
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
| | - Wei Wang
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
| | - Yingcai Hong
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
| | - Huadong Zhang
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
| | - Chengying Hong
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
| | - Xueyan Liu
- Intensive Care Unit, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, P.R. China
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Abstract
Gut barrier failure is often present in severe acute pancreatitis (SAP), and it increases the gut permeability, leads to translocation of bacteria or endotoxin, causes severe infection and multiple organ dysfunction syndrome, and worsens the course of the disease. The injury of gut barrier may result from the interactions among microcirculation disturbance, ischemia-reperfusion injury, excessive release of inflammatory mediators, apoptosis, flora imbalance and so on. The research on the mechanism of gut barrier failure caused by SAP is of important significance for the treatment of SAP.
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Jacquet-Lagrèze M, Allaouchiche B, Restagno D, Paquet C, Ayoub JY, Etienne J, Vandenesch F, Dauwalder O, Bonnet JM, Junot S. Gut and sublingual microvascular effect of esmolol during septic shock in a porcine model. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:241. [PMID: 26041462 PMCID: PMC4490718 DOI: 10.1186/s13054-015-0960-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Esmolol may efficiently reduce heart rate (HR) and decrease mortality during septic shock. An improvement of microcirculation dissociated from its macrocirculatory effect may a role. The present study investigated the effect of esmolol on gut and sublingual microcirculation in a resuscitated piglet model of septic shock. METHODS Fourteen piglets, anesthetized and mechanically ventilated, received a suspension of live Pseudomonas aeruginosa. They were randomly assigned to two groups: the esmolol (E) group received an infusion of esmolol, started at 7.5 μg⋅kg(-1)⋅min(-1), and progressively increased to achieve a HR below 90 beats⋅min(-1). The control (C) group received an infusion of Ringer's lactate solution. HR, mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), systemic vascular resistance (SVR), arterio-venous blood gas and lactate were recorded. Oxygen consumption (VO2), delivery (DO2) and peripheral extraction (O2ER) were computed. Following an ileostomy, a laser Doppler probe was applied on ileal mucosa to monitor gut microcirculatory laser Doppler flow (GMLDF). Videomicroscopy was also used on ileal mucosa and sublingual areas to evaluate mean flow index (MFI), heterogeneity, ratio of perfused villi and proportion of perfused vessels. Resuscitation maneuvers were performed following a defined algorithm. RESULTS Bacterial infusion induced a significant alteration of the gut microcirculation with an increase in HR. Esmolol produced a significant time/group effect with a decrease in HR (P <0.004) and an increase in SVR (P <0.004). Time/group effect was not significant for CI and MAP, but there was a clear trend toward a decrease in CI and MAP in the E group. Time/group effect was not significant for SI, O2ER, DO2, VO2, GMLDF and lactate. A significant time/group effect of ileal microcirculation was found with a lower ileal villi perfusion (P <0.025) in the C group, and a trend toward a better MFI in the E group. No difference between both groups was found regarding microcirculatory parameters in the sublingual area. CONCLUSIONS Esmolol provided a maintenance of microcirculation during sepsis despite its negative effects on macrocirculation. Some parameters even showed a trend toward an improvement of the microcirculation in the gut area in the esmolol group.
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Affiliation(s)
- Matthias Jacquet-Lagrèze
- Service d'anesthésie-réanimation, Hospices Civils de Lyon, Hôpital Edouard-Herriot, 5 place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Bernard Allaouchiche
- Service d'anesthésie-réanimation, Hospices Civils de Lyon, Hôpital Edouard-Herriot, 5 place d'Arsonval, 69437, Lyon, Cedex 03, France. .,Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France.
| | - Damien Restagno
- EA 4174 Sepsis Inflammation Hémostase, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy-l'Étoile, France.
| | - Christian Paquet
- EA 4174 Sepsis Inflammation Hémostase, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy-l'Étoile, France.
| | - Jean-Yves Ayoub
- EA 4174 Sepsis Inflammation Hémostase, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy-l'Étoile, France.
| | - Jêrome Etienne
- Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France. .,Laboratory of Microbiology, Groupement Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France.
| | - François Vandenesch
- Université Claude-Bernard, Lyon 1. Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France. .,Laboratory of Microbiology, Groupement Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France.
| | - Olivier Dauwalder
- Laboratory of Microbiology, Groupement Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France.
| | - Jeanne-Marie Bonnet
- EA 4174 Sepsis Inflammation Hémostase, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy-l'Étoile, France.
| | - Stéphane Junot
- EA 4174 Sepsis Inflammation Hémostase, Université de Lyon, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy-l'Étoile, France.
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Groesdonk HV, Raffel M, Speer T, Bomberg H, Schmied W, Klingele M, Schäfers HJ. Elevated endothelin-1 level is a risk factor for nonocclusive mesenteric ischemia. J Thorac Cardiovasc Surg 2014; 149:1436-42.e2. [PMID: 25623906 DOI: 10.1016/j.jtcvs.2014.12.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Nonocclusive mesenteric ischemia may occur after cardiac surgery, commonly in conjunction with the use of cardiopulmonary bypass. Some evidence suggests that endothelin-1 serum levels are increased in patients with mesenteric ischemia, but the association of endothelin-1 and nonocclusive mesenteric ischemia has not been studied. The objective was to investigate whether elevated levels of endothelin-1 could be found in patients exhibiting nonocclusive mesenteric ischemia. METHODS In an observational cohort study, nonocclusive mesenteric ischemia developed in 78 of 865 patients undergoing elective cardiac surgery. Control patients were identified from the cohort through 1:1 propensity score matching. Preoperative and postoperative endothelin-1 serum levels were determined by means of enzyme-linked immunosorbent assay. Odds ratios (with 95% confidence interval) were calculated by logistic regression analyses to determine the risk of endothelin-1 for the development of nonocclusive mesenteric ischemia. RESULTS Patients with nonocclusive mesenteric ischemia had higher preoperative (11.3 vs 9.3 pg/mL; P = .001) and postoperative (15.7 vs 11.1 pg/mL, P < .001) levels of endothelin-1 than the controls. The probability of developing nonocclusive mesenteric ischemia increased with each picogram/milliliter endothelin-1 level preoperatively (odds ratio, 1.29; 95% confidence interval, 1.12-1.49) and each picogram/milliliter postoperatively (odds ratio, 2.04; 95% confidence interval, 1.54-2.72). Receiver operating characteristic analyses showed that elevated endothelin-1 serum levels had a high accuracy to predict nonocclusive mesenteric ischemia (optimal cutoff value of 14.5 pg/mL, area under the curve of 0.77, sensitivity 51%, and specificity 94%). CONCLUSIONS Endothelin-1 seems to predispose patients undergoing cardiac surgery to develop nonocclusive mesenteric ischemia. In addition, it may be a useful marker to identify patients at risk for nonocclusive mesenteric ischemia after cardiac surgery.
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Affiliation(s)
- Heinrich V Groesdonk
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Miriam Raffel
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thimoteus Speer
- Division of Nephrology and Hypertension, Department of Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hagen Bomberg
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany; Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Wolfram Schmied
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Matthias Klingele
- Division of Nephrology and Hypertension, Department of Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
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Kowalczyk A, Kleniewska P, Kolodziejczyk M, Skibska B, Goraca A. The role of endothelin-1 and endothelin receptor antagonists in inflammatory response and sepsis. Arch Immunol Ther Exp (Warsz) 2014; 63:41-52. [PMID: 25288367 PMCID: PMC4289534 DOI: 10.1007/s00005-014-0310-1] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/18/2014] [Indexed: 12/12/2022]
Abstract
Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor, mainly secreted by endothelial cells. It acts through two types of receptors: ETA and ETB. Apart from a vasoconstrictive action, ET-1 causes fibrosis of the vascular cells and stimulates production of reactive oxygen species. It is claimed that ET-1 induces proinflammatory mechanisms, increasing superoxide anion production and cytokine secretion. A recent study has shown that ET-1 is involved in the activation of transcription factors such as NF-κB and expression of proinflammatory cytokines including TNF-α, IL-1, and IL-6. It has been also indicated that during endotoxaemia, the plasma level of ET-1 is increased in various animal species. Some authors indicate a clear correlation between endothelin plasma level and morbidity/mortality rate in septic patients. These pathological effects of ET-1 may be abrogated at least partly by endothelin receptor blockade. ET-1 receptor antagonists may be useful for prevention of various vascular diseases. This review summarises the current knowledge regarding endothelin receptor antagonists and the role of ET-1 in sepsis and inflammation.
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Affiliation(s)
- Agata Kowalczyk
- Chair of Experimental and Clinical Physiology, Department of Cardiovascular Physiology, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland,
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Jacquet-Lagrèze M, Bonnet-Garin JM, Allaouchiche B, Vassal O, Restagno D, Paquet C, Ayoub JY, Etienne J, Vandenesch F, Daulwader O, Junot S. A new device for continuous assessment of gut perfusion: proof of concept on a porcine model of septic shock. Crit Care 2014; 18:R153. [PMID: 25030376 PMCID: PMC4223372 DOI: 10.1186/cc13992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/24/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION We evaluate an innovative device consisting of an enteral feeding tube equipped with a photoplethysmography (PPG) sensor in contact with the duodenal mucosa. This study aims to determine if the PPG signal, composed of a continuous (PDC) and a pulsatile part (PAC), is a reliable method to assess gut perfusion in a porcine model of septic shock. METHOD Fourteen piglets were anesthetized and mechanically ventilated. They were randomly assigned to two groups: the nonseptic (NS) group received an infusion of Ringer's lactate solution (RL) alone, the septic (S) group received in addition a suspension of live Pseudomonas aeruginosa. Heart rate (HR), pulse oximetry (SpO2), mean arterial pressure (MAP), cardiac index (CI) and serum lactates were recorded and gut microcirculation (GM) was monitored with a laser Doppler probe applied on the duodenal serosa. PDC and PAC were given by the PPG probe inserted in the duodenum. Data was collected every 15 minutes (t0, t15…) during 150 minutes (t150). After administration of the bacteria suspension (t0), resuscitation maneuvers were performed following a defined algorithm. GM PAC, and PDC were expressed as variation from baseline (GMvar, PACvar, PDCvar). Analysis of variance (ANOVA) with repeated measures was performed to compare hemodynamic variables, with Bonferroni correction as post hoc analysis on t0, t60 and t150. RESULTS One piglet was withdrawn from analysis due to a defective probe. S group (six piglets) received resuscitation therapy while NS group (seven piglets) did not. A significant group effect was found for the all parameters except HR. Post hoc analysis found a significant decrease for GM and PAC at t60. The correlation between PAC, PDC and microcirculatory parameters were as follows: rPACvar-GMvar = 0.496, P <0.001, rPDCvar-GMvar = 0.244; P = 0.002. In the septic group, correlations were as follows: rPAC-lactate = -0.772, P <0.001; rPDC-lactate = -0.681, P <0.01). At the onset of shock, a decrease of PAC, PDC and GM occurred before the alteration of MAP. CONCLUSIONS PAC and PDC decreased at the onset of shock and were correlated with GM and lactate. These results confirm that PPG signal reliably reflects the early perfusion alteration of the gut. Further studies should assess the clinical use of this device.
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Affiliation(s)
- Matthias Jacquet-Lagrèze
- Service d’Anesthésie-Réanimation, Hospices Civils de Lyon, hôpital Edouard-Herriot, 5 place d’Arsonval, 69437 Lyon, Cedex 03, France
| | - Jeanne-Marie Bonnet-Garin
- Université de Lyon, EA 4174 Hémostase, Inflammation et Sepsis, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Étoile, France
| | - Bernard Allaouchiche
- Service d’Anesthésie-Réanimation, Hospices Civils de Lyon, hôpital Edouard-Herriot, 5 place d’Arsonval, 69437 Lyon, Cedex 03, France
- Université Claude Bernard, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, Lyon, France
| | - Olivia Vassal
- Service d’Anesthésie-Réanimation, Hospices Civils de Lyon, hôpital Edouard-Herriot, 5 place d’Arsonval, 69437 Lyon, Cedex 03, France
| | - Damien Restagno
- Université de Lyon, EA 4174 Hémostase, Inflammation et Sepsis, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Étoile, France
| | - Christian Paquet
- Université de Lyon, EA 4174 Hémostase, Inflammation et Sepsis, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Étoile, France
| | - Jean-Yves Ayoub
- Université de Lyon, EA 4174 Hémostase, Inflammation et Sepsis, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Étoile, France
| | - Jérôme Etienne
- Université Claude Bernard, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, Lyon, France
- Laboratoire de Microbiologie, Groupement Hospitalier Est, Lyon, France
| | - François Vandenesch
- Université Claude Bernard, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, Lyon, France
- Laboratoire de Microbiologie, Groupement Hospitalier Est, Lyon, France
| | - Olivier Daulwader
- Laboratoire de Microbiologie, Groupement Hospitalier Est, Lyon, France
| | - Stéphane Junot
- Université de Lyon, EA 4174 Hémostase, Inflammation et Sepsis, VetAgro Sup - Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280 Marcy l'Étoile, France
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Huang HL, Nie X, Wu B, He Y, Song HL, Luo TX, Gao BX, Li GX. Association of endotoxin and endothelin-1 with acute kidney injury in patients with acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2013; 21:1549-1553. [DOI: 10.11569/wcjd.v21.i16.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the association of endotoxin and endothelin-1 with acute kidney injury in patients with acute pancreatitis (AP).
METHODS: Fifty-two AP patients with acute kidney injury and equal number of AP patients without acute kidney injury were enrolled in this study. Blood samples were obtained from all patients for laboratory analysis of liver function, renal function, electrolytes, procalcitonin (PCT) and endothelin-1 (ET-1).
RESULTS: The SIRS score showed no significant difference between cases and controls (2.66 ± 0.86 vs 2.30 ± 1.00, t = 1.90, P > 0.05), indicating that both groups suffered from systemic inflammatory response. The levels of PCT (23.24 ng/mL vs 0.23 ng/mL, Z = -7.31, P < 0.05) , ET-1 (7.61 pg/mL ± 2.17 pg/mL vs 2.34 pg/mL ± 1.28 pg/mL, t = 4.98, P < 0.05), urea (Z = -2.17), creatinine (Z = -7.69) and cystatin C (Z = -8.39) were significantly higher in cases than in controls. The mortality and improvement rates also differed significantly between cases and controls (36.5% vs 5.8%; 21.2% vs 94.2%, χ2 = 141.92, P < 0.05).
CONCLUSION: Endotoxin and ET-1 are closely associated with the development of acute kidney injury possibly by inducing severe renal vasoconstriction.
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Stanek C, Reinhardt N, Diesing AK, Nossol C, Kahlert S, Panther P, Kluess J, Rothkötter HJ, Kuester D, Brosig B, Kersten S, Dänicke S. A chronic oral exposure of pigs with deoxynivalenol partially prevents the acute effects of lipopolysaccharides on hepatic histopathology and blood clinical chemistry. Toxicol Lett 2012; 215:193-200. [DOI: 10.1016/j.toxlet.2012.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 02/02/2023]
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Bomberg H, Bierbach B, Flache S, Wagner I, Gläser L, Groesdonk HV, Menger MD, Schäfers HJ. Endothelin and vasopressin influence splanchnic blood flow distribution during and after cardiopulmonary bypass. J Thorac Cardiovasc Surg 2012; 145:539-47. [PMID: 22551769 DOI: 10.1016/j.jtcvs.2012.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/13/2012] [Accepted: 03/12/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Gastrointestinal blood flow can be compromised during and after cardiopulmonary bypass. Endothelin has been shown to be involved in the intestinal microcirculatory disturbance of sepsis. The aim of the present study was to analyze the involvement of the endothelin system on intestinal blood flow regulation during cardiopulmonary bypass and the effect of vasopressin given during cardiopulmonary bypass. METHODS A total of 24 pigs were studied in 4 groups (n = 6): group I, sham; group II, ischemia/reperfusion with 1 hour of superior mesenteric artery occlusion; group III, cardiopulmonary bypass for 1 hour; and group IV, 1 hour of cardiopulmonary bypass plus vasopressin administration, maintaining the baseline arterial pressure. All the pigs were reperfused for 90 minutes. During the experiment, the hemodynamics and jejunal microcirculation were measured continuously. The jejunal mucosal expression of endothelin-1 and its receptor subtypes A and B were determined using polymerase chain reaction. RESULTS During cardiopulmonary bypass, superior mesenteric artery flow was preserved but marked jejunal microvascular impairment occurred compared with baseline (mucosal capillary density, 192.2 ± 5.4 vs 150.8 ± 5.1 cm/cm(2); P = .005; tissue blood flow, 501.7 ± 39.3 vs 332.3 ± 27.9 AU; P = .025). The expression of endothelin-1 after cardiopulmonary bypass (3.2 ± 0.4 vs 12.2 ± 0.8 RQ, P = .006) and endothelin subtype A (0.7 ± 0.2 vs 2.4 ± 0.6 RQ; P = .01) was significantly increased compared to the sham group. Vasopressin administration during cardiopulmonary bypass led to normal capillary density (189.9 ± 3.9 vs 178.0 ± 6.3; P = .1) and tissue blood flow (501.7 ± 39.3 vs 494.7 ± 44.4 AU; P = .4) compared with baseline. The expression of endothelin-1 (3.2 ± 0.4 vs 1.8 ± 0.3 RQ; P = .3) and endothelin subtype A (0.7 ± 0.2 vs 0.9 ± 0.2 RQ; P = .5) was not different from the sham group. CONCLUSIONS Cardiopulmonary bypass leads to microvascular impairment of jejunal microcirculation, which is associated with the upregulation of endothelin-1 and endothelin subtype A. The administration of vasopressin minimizes these cardiopulmonary bypass-associated alterations.
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Affiliation(s)
- Hagen Bomberg
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany
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Andersson A, Rundgren M, Kalman S, Rooyackers O, Brattstrom O, Oldner A, Eriksson S, Frithiof R. Gut microcirculatory and mitochondrial effects of hyperdynamic endotoxaemic shock and norepinephrine treatment. Br J Anaesth 2012; 108:254-61. [DOI: 10.1093/bja/aer379] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Current World Literature. Curr Opin Nephrol Hypertens 2012; 21:106-18. [DOI: 10.1097/mnh.0b013e32834ee42b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fenhammar J, Andersson A, Forestier J, Weitzberg E, Sollevi A, Hjelmqvist H, Frithiof R. Endothelin receptor A antagonism attenuates renal medullary blood flow impairment in endotoxemic pigs. PLoS One 2011; 6:e21534. [PMID: 21760895 PMCID: PMC3132177 DOI: 10.1371/journal.pone.0021534] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/31/2011] [Indexed: 12/30/2022] Open
Abstract
Background Endothelin-1 is a potent endogenous vasoconstrictor that contributes to renal microcirculatory impairment during endotoxemia and sepsis. Here we investigated if the renal circulatory and metabolic effects of endothelin during endotoxemia are mediated through activation of endothelin-A receptors. Methods and Findings A randomized experimental study was performed with anesthetized and mechanically ventilated pigs subjected to Escherichia coli endotoxin infusion for five hours. After two hours the animals were treated with the selective endothelin receptor type A antagonist TBC 3711 (2 mg⋅kg−1, n = 8) or served as endotoxin-treated controls (n = 8). Renal artery blood flow, diuresis and creatinine clearance decreased in response to endotoxemia. Perfusion in the cortex, as measured by laser doppler flowmetry, was reduced in both groups, but TBC 3711 attenuated the decrease in the medulla (p = 0.002). Compared to control, TBC 3711 reduced renal oxygen extraction as well as cortical and medullary lactate/pyruvate ratios (p<0.05) measured by microdialysis. Furthermore, TBC 3711 attenuated the decline in renal cortical interstitial glucose levels (p = 0.02) and increased medullary pyruvate levels (p = 0.03). Decreased creatinine clearance and oliguria were present in both groups without any significant difference. Conclusions These results suggest that endothelin released during endotoxemia acts via endothelin A receptors to impair renal medullary blood flow causing ischemia. Reduced renal oxygen extraction and cortical levels of lactate by TBC 3711, without effects on cortical blood flow, further suggest additional metabolic effects of endothelin type A receptor activation in this model of endotoxin induced acute kidney injury.
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Affiliation(s)
- Johan Fenhammar
- Department of Anaesthesiology & Intensive Care, Karolinska University Hospital Huddinge, Huddinge, Stockholm, Sweden.
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