CIRCULATING ENDOTHELIN AND NITRATE-NITRITE RELATE TO HEMODYNAMIC AND METABOLIC VARIABLES IN HUMAN SEPTIC SHOCK
| Autor: | L. G. Thijs, J. Visser, M. C. M. De Groot, A. B. J. Groeneveld, Koen J. Hartemink |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty Cardiotonic Agents Dopamine Vasodilator Agents Hemodynamics Vasodilation Nitric Oxide Critical Care and Intensive Care Medicine Norepinephrine Internal medicine Blood plasma Humans Medicine Prospective Studies Nitrites Aged Aged 80 and over Nitrates Tumor Necrosis Factor-alpha business.industry Septic shock Endothelins Middle Aged medicine.disease Shock Septic Intensive Care Units medicine.anatomical_structure Endocrinology Creatinine Shock (circulatory) Hyperdynamic circulation Emergency Medicine Vascular resistance Blood Vessels Cytokines Female medicine.symptom business Endothelin receptor |
| Zdroj: | Shock. 11:160-166 |
| ISSN: | 1073-2322 |
| Popis: | Activation of the nitric oxide (NO) pathway over that of endothelin in the vessel wall, as judged from circulating endothelin and nitrate-nitrite (NN) levels, may partly account for the hypotension associated with vasodilation, diminished catecholamine sensitiveness and O 2 extraction, and lactic acidemia in human septic shock. In a prospective study, 14 consecutive patients with septic shock and a pulmonary artery catheter in place were included. For 3 days after admission, serial measurements of hemodynamic variables and plasma levels of endothelin and NN were done. The patients had a hyperdynamic circulation. Except for a higher final blood lactate level and more treatment with vasoconstricting catecholamines in nonsurvivors, global hemodynamic and O 2 -related variables did not differ between outcome groups. On the day of admission, circulating endothelin and NN levels were elevated and related to elevated levels of tumor necrosis factor-α and interleukin-6. The levels of endothelin increased in time in nonsurvivors as compared with survivors. The NN levels declined in survivors but not in nonsurvivors. The systemic vascular resistance indices (SVRI), global O 2 extraction ratios, and blood lactate levels directly related to the endothelin levels. SVRI and global O 2 extraction ratios inversely, and the lactate blood levels directly, related to NN levels, and the hemodynamic and metabolic parameters related directly to the ratio between endothelin and NN plasma levels on the days of the study. The vessel wall factors did not relate to the creatinine levels. The results suggest that the hemodynamic and metabolic peripheral abnormalities of human septic shock are mediated in part by cytokine-activated endothelin and NO systems in the vessel wall. They also suggest that increased production rather than diminished renal clearance accounts for elevated levels of NN and endothelin and that the latter are associated with a poor outcome. |
| Databáze: | OpenAIRE |
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