BJA Advance Access originally published online on November 3, 2007
British Journal of Anaesthesia 2008 100(1):55-65; doi:10.1093/bja/aem278
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Effects of sodium nitroprusside on splanchnic microcirculation in a resuscitated porcine model of septic shock
1 Department of Anaesthesia and
2 Laboratory of biochemistry, Edouard Herriot Hospital, 5, Place Arsonval, 69437 Lyon cedex 03, France
3 Laboratory of Pathophysiology of Anaesthesia EA 1896, University Claude Bernard, Lyon1, 8, avenue Rockefeller, 69373 Lyon, France
* Corresponding author: 210, rue Marcel Mérieux, 69007 Lyon, France. E-mail: assadinasser{at}yahoo.com
Background: We tested the hypothesis that sodium nitroprusside (SNP) might improve the impairment of hepatosplanchnic microcirculatory blood flow (MBF) in septic shock.
Methods: Fourteen pigs were anaesthetized and their lungs mechanically ventilated. Sepsis was induced with i.v. infusion of live Pseudomonas aeruginosa [1x108 colony forming units (CFU) ml–1 kg–1] for 1 h. Sixty minutes later, the animals received in a random succession either SNP or normal saline for 30 min. Mean arterial pressure (MAP), cardiac index (CI), mean pulmonary artery pressure (MPAP), carbon dioxide tension of the ileal mucosa (PCO2; by gas tonometry), ileal mucosal and hepatic MBF by laser Doppler flowmetry, blood gases, and lactates were assessed before, during administration, and 30 min after discontinuing the test drug.
Results: Bacterial infusion promoted hypodynamic shock (MAP –18%, CI –33%, ileal MBF –19%, and hepatic MBF –27%), which was converted to normodynamic shock by resuscitation. During SNP infusion, ileal mucosal MBF significantly increased (+19%) compared with control (P = 0.033). Although hepatic MBF increased (+42% from baseline), this did not differ from control. In order to maintain a constant central venous pressure and MAP, fluid loading and norepinephrine (P < 0.01) were increased. Acid–base status was not altered by SNP.
Conclusions: In a resuscitated porcine model of the early phase of septic shock, SNP improved ileal mucosal MBF but required a concomitant increase in fluid and norepinephrine supplements to maintain constant systemic haemodynamic parameters.
Keywords: complications, infections, sepsis; gastrointestinal tract, mucosal perfusion; measurement techniques, laser Doppler flowmetry; pharmacology, nitroglycerin
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