Hepato-splanchnic metabolic effects of the stable prostacyclin analogue iloprost in patients with septic shock
| Autor: | I. Tugtekin, Ulrich Wachter, Hendrik Bracht, Manfred Weiss, Cigdem Altin, Peter Radermacher, Josef Vogt, Heide Wiedeck, Peter Kiefer, Michael K. Georgieff |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Mean arterial pressure Vasodilator Agents Cardiac index Apparent oxygen utilisation Critical Care and Intensive Care Medicine Statistics Nonparametric pCO2 Internal medicine medicine Humans Iloprost Prospective Studies Splanchnic Circulation Infusions Intravenous Aged Septic shock business.industry Hemodynamics Middle Aged medicine.disease Shock Septic Surgery Oxygen Shock (circulatory) cardiovascular system Cardiology Female medicine.symptom Splanchnic business Liver Circulation circulatory and respiratory physiology medicine.drug |
| Zdroj: | Intensive Care Medicine. 27:1179-1186 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/s001340100954 |
| Popis: | Objective: To evaluate the effects of the stable prostacyclin analogue iloprost on hepato-splanchnic blood flow, oxygen exchange and metabolism in patients with septic shock. Design: Prospective clinical study. Setting: Intensive care unit in a university clinic. Patients: Eleven patients with septic shock requiring norepinephrine to maintain mean arterial pressure above 70 mmHg. Interventions: Iloprost was incrementally infused to increase cardiac index by 15%. Measurements and main results: Splanchnic blood flow (Qspl) was measured using the steady-state indocyanine-green infusion technique and endogenous glucose production rate (EGP) using a stable isotope approach. Systemic and splanchnic oxygen consumption (VO2), the hepato-splanchnic uptake rates of the glucose precursors lactate, pyruvate, alanine and glutamine, the hepatic venous redox state and gastric mucosal-arterial PCO2 gradients were determined. After a baseline measurement, iloprost infusion was started. After 90 min all measurements were repeated and a third measurement was obtained after another 90 min following iloprost withdrawal. Qspl (baseline I: 0.82/0.75–1.08 l·min·m2; iloprost: 0.94/0.88–1.29 l·min·m2; baseline II: 0.87/0.74–1.09 l·min·m2) and splanchnic oxygen delivery (baseline I: 122/103–166 ml·min·m2; iloprost: 134/117–203 ml·min·m2; baseline II: 130/98–158 ml·min·m2) significantly increased. While systemic VO2 significantly increased (baseline I: 139/131–142 ml·min·m2; iloprost: 147/136–164 ml·min·m2; baseline II: 143/133–154 ml·min·m2) splanchnic VO2 increased in 9 of 11 patients which, however, did not reach statistical significance. EGP significantly decreased (baseline I: 23/16–26 µmol·kg·min; iloprost: 16/14–21 µmol·kg·min; baseline II: 18/12–20 µmol·kg·min), whereas all other parameters of energy metabolism remained unchanged. Conclusion: In patients with septic shock an iloprost-induced increase in cardiac index increased splanchnic blood flow and shifted oxygen utilization from the energy requiring de novo glucose production rate to other oxygen-demanding metabolic pathways. |
| Databáze: | OpenAIRE |
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