Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Eight patients with severe sepsis, four with septic shock, and eight without sepsis were studied to investigate whether skeletal muscle influences the whole body O2 consumption (VO2)-O2 delivery relationship and hemodynamics. A forearm VO2-O2 delivery dependency was observed only in nonseptic patients, in whom no whole body VO2-O2 delivery dependency appeared. ⋯ Neither a relationship between forearm VO2 and whole body VO2 nor between FAR and SVR was found in any groups of patients. Septic shock was associated with low FAR that was not affected by the FBF decrease, indicating that in this condition, hemodynamics could be influenced by skeletal muscle resistance.
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Comparative Study Clinical Trial
Volumetric assessment of preload in trauma patients: addressing the problem of mathematical coupling.
The availability of the volumetric thermodilution pulmonary artery catheter allows preload assessment based on ventricular volume rather than pressure. This technique has been shown clinically to be a better measure of preload than the pulmonary artery occlusion pressure (PAOP). Critics of the technique argue that the use of thermodilution to measure cardiac output (CO) accounts for the better correlation between right ventricular end-diastolic volume (RVEDV) and CO than PAOP and CO, since stroke volume derived from the CO is a common term to both RVEDV and CO. ⋯ RVEDV was significantly better than PAOP at predicting both COTH (p < .001) and COFICK (p = .04). Multivariate regression analysis confirmed that RVEDV was the only estimate of preload which was significantly related to CO. We conclude that mathematical coupling does not have a significant clinical effect on the relationship between RVEDV and CO.
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Cytokines and eicosanoids are well documented important mediators of endotoxemia. Bicyclic imidazoles are a novel class of nonsteroidal anti-inflammatory compounds that display unique pharmacological profiles by reducing cytokine production and arachidonic acid metabolism. In this study, we evaluated the ability of the bicyclic imidazole, SK&F 86002, to attenuate endotoxin-induced cardiopulmonary dysfunction. ⋯ SK&F 86002 blocked the LPS-induced increase in myeloperoxidase activity, indicating a reduction in pulmonary neutrophil infiltration, but had no effect on systemic leukopenia. Pretreatment with SK&F 86002 significantly attenuated LPS-induced increases in plasma thromboxane B2 and tumor necrosis factor-alpha. We hypothesize that ameliorating effects of SK&F 86002 in this endotoxin model of cardiopulmonary dysfunction are related to inhibition of cytokine and eicosanoid biosynthesis.