Circulatory shock
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The effects of milrinone were investigated in a porcine septic shock model. Septic shock was induced by i.v. infusion of live Escherichia coli. Anesthetized pigs were treated with milrinone before the E. coli infusion or were left untreated as septic controls. ⋯ Pulmonary vasoconstriction was little affected by pre-treatment with milrinone. Four out of seven milrinone-treated pigs died during the observation period. It is concluded that in the settings of the used porcine septic shock model milrinone treatment has no beneficial effect.
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Previous studies have shown that fluid resuscitation in septic shock improves oxygen consumption. Red cell transfusion during resuscitation from septic shock has also been shown to enhance oxygen consumption in patients with elevated lactate levels. This study investigates the effect of increasing oxygen delivery (DO2) through an isolated increase in arterial oxygen content following adequate fluid resuscitation from septic shock in humans. ⋯ Subset analysis revealed that a pretransfusion oxygen extraction ratio under 24% was associated with an increase in VO2, but the pretransfusion level of cardiac index, PAWP, lactate, or VO2 was not. An isolated increase in arterial oxygen content as a means of increasing DO2 does not improve VO2 in septic shock following adequate fluid resuscitation. Patients with a low oxygen extraction ratio (less than 24%) represent a subset of patients which did improve consumption with transfusion, and may represent a more severe microcirculatory disturbance not amenable to fluid loading.