Prostacyclin In Septic Shock

Prostacyclin In Septic Shock

Hannemann L; Reinhart K; Meierhellmann A; Bredle D L

Chest

1994

1994-05

Objective: Investigation of the hypothesis that the infusion of 10 ng/kg/min prostacyclin (epoprostenol) (PGI(2)) improves O-2 uptake in patients with hyperdynamic septic shock. Design: Prospective, single cohort design. Setting: ICU, university hospital. Patients: Fifteen postoperative patients with septic shock. Interventions: Infusion of 10 ng/kg/min of PGI(2) for 60 min. Measurements: Complete hemodynamic profile with O-2 transport-related variables (simultaneous measurements of Vo(2) from the respiratory gases and by cardiovascular Fick) and blood lactate levels before start of the PGI(2)-infusion and 60 min thereafter. Main results: Oxygen delivery increased significantly (14 percent) from its already high value, 750+/-238 to 852+/-214 ml/min/m(2). The O-2 extraction ratio remained unchanged. When Vo(2) was measured from the respiratory gases, it was unchanged. When Vo(2) was measured by cardiovascular Fick, it increased slightly (p<0.05). Conclusions: We conclude that in this O-2 challenge test with PGI(2) in patients with septic shock, an increase in O-2 delivery was not matched by an increase in Vo(2). We believe that the adequate conventional support of these patients may have prevented the PGI(2) from revealing a ''covert'' O-2 debt. The PGI(2) test did not predict mortality by O-2 supply dependency. The small increase in Vo(2) as calculated indirectly suggests a degree of mathematical coupling of O-2 delivery and uptake.

critically; delivery; failure; General & Internal Medicine; ill patients; increases oxygen-consumption; infusion; lactate; norepinephrine therapy; Respiratory System; respiratory-distress syndrome; sepsis; tissue oxygenation

Journal Article or Conference Abstract Publication

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1504-1510

5

105