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BJA Advance Access originally published online on October 25, 2007
British Journal of Anaesthesia 2007 99(6):830-836; doi:10.1093/bja/aem295
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Exogenous adrenomedullin prevents and reverses hypodynamic circulation and pulmonary hypertension in ovine endotoxaemia

C. Ertmer1,*, A. Morelli2, S. Rehberg1, M. Lange1, C. Hucklenbruch1, H. Van Aken1, M. Booke3 and M. Westphal1

1 Department of Anaesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany
2 Department of Anaesthesiology and Intensive Care, University of Rome ‘La Sapienza’, Piazzale Aldo Moro 5, 00185 Roma, Italy
3 Department of Anaesthesiology, Intensive Care and Pain Therapy, ‘Kliniken des Main-Taunus-Kreises’, Kronberger Str. 36, D-65812 Bad Soden, Germany

* Corresponding author. E-mail: ertmerc{at}gmx.net

Background: Hypodynamic septic shock is associated with a poor prognosis. The present randomized-controlled laboratory experiment was designed to test the hypothesis that the vasodilatory peptide hormone adrenomedullin (ADM) is a useful agent to prevent and reverse the development of hypodynamic circulation in ovine endotoxaemia.

Methods: Twenty-four healthy ewes were chronically instrumented for haemodynamic monitoring and randomly allocated to either the control, treatment, or prophylaxis group (n = 8 each). After a baseline (BL) measurement in the healthy state, all sheep were subjected to a continuous endotoxin infusion started at 10 ng kg–1 min–1 and doubled every hour six times. After 4 h of endotoxin challenge, the treatment group received ADM (50 ng kg–1 min–1) for the remaining 3 h of the experiment. The prophylaxis group received a simultaneous infusion of endotoxin and ADM (50 ng kg–1 min–1) from the beginning to the end of the 7 h intervention period.

Results: In the control and treatment groups, the ewes exhibited a hypodynamic circulation at 4 h (>20% reduction in cardiac index, both P < 0.01 vs BL). Endotoxin also increased mean pulmonary arterial pressure (MPAP) and arterial lactate concentrations. Prophylactic infusion of ADM prevented the occurrence of pulmonary hypertension and hypodynamic circulation and thereby blunted the increase in arterial lactate concentrations. In the treatment group, ADM administration increased CI (P < 0.001) and reduced both MPAP (P = 0.023) and arterial lactate concentrations (P < 0.001 each at 7 h) when compared with the control group.

Conclusions: This study demonstrates that exogenous ADM prevents and reverses hypodynamic circulation, attenuates pulmonary hypertension, and limits lactic acidosis in ovine endotoxaemia.

Keywords: heart, cardiac output; heart, inotropism; polypeptides; sheep; shock, septic


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