β‐Blockade attenuates renal blood flow in experimental endotoxic shock by reducing perfusion pressure

In an acute endotoxic septic shock sheep model, we studied the effects of esmolol (an ultrashort acting ß1‐selective adrenoceptor antagonist) administration on renal blood flow and the static and dynamic renal autoregulation during acute septic shock. Our data reveal that both the resuscitated endotoxin shock and the β‐blocker infusion left the renal autoregulation parameters unchanged. However, esmolol reduced the perfusion pressure to critical values thereby significantly reducing renal blood flow. AbstractClinical data suggests that heart rate (HR) control with selective β1‐blockers may improve cardiac function during septic shock. However, it seems counterintuitive to start β‐blocker infusion in a shock state when organ blood flow is already low or insufficient. Therefore, we studied the effects of HR control with esmolol, an ultrashort‐ acting β1‐select ive adrenoceptor antagonist, on renal blood flow (RBF) and renal autoregulation during early septic shock. In 10 healthy sheep, sepsis was induced by continuous i.v. administration of lipopolysaccharide, while maintained under anesthesia and mechanically ventilated. After successful resuscitation of the septic shock with fluids and vasoactive drugs, esmolol was infused to reduce HR with 30% and was stopped 30‐min after reaching this target. Arterial and venous pressures, and RBF were recorded continuously. Renal autoregulation was evaluated by the response in RBF to renal perfusion ...
Source: Physiological Reports - Category: Physiology Authors: Tags: ORIGINAL RESEARCH Source Type: research

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Conclusion The impact of sepsis on the gut is manifold, e.g., sepsis mediated alteration of the gut-blood barrier and increase in the intestinal permeability, which may correlate with the phenomena of bacterial translocation and lymphatic activation (“toxic-lymph”). Systemic consequences of sepsis are widespread and concern to the coagulative system, the microbiome as well as enzymes, such as pancreatic proteases, MMPs and IAPs. Nevertheless, the therapeutic approaches for modulating the mucosal immune system are still rarely effective in daily routine. Recent published studies showing that treatment with FMT,...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Background: Noninvasive evaluation of muscle perfusion using near-infrared spectroscopy (NIRS) coupled with a vascular occlusion test (VOT) may provide an early and simple marker of altered perfusion and microcirculatory function in sepsis. Objective: The aim of the study was to compare the time-course of NIRS-derived variables with systemic measures of perfusion in an experimental model of peritonitis. Methods: Peritonitis was induced in eight anesthetized, mechanically ventilated, adult sheep (24–34 kg), by injecting autologous feces into the peritoneal cavity. Animals were followed until death or for a max...
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
We appreciate the comments from Dr. Jha. According to the study protocol, all patients received a cardiac output monitor aiming to optimize fluid status and cardiac index. Therefore, as our data show, with norepinephrine or vasopressin, we did not observe either a reduction in the cardiac index or a worsening of tissue perfusion and oxygenation parameters as lactate and central venous oxygen saturation.1 Furthermore, the incidence of low cardiac output and cardiogenic shock in the norepinephrine and vasopressin groups was not different. We attribute this to the fact that we assessed the fluid status and used inotropes regu...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Conclusions There is a moderate correlation between SvO2 and SvcO2; however, the concordance between them is inadequate. It was not possible to demonstrate that the presence of hypoperfusion alters the concordance between SvO2 and SvcO2. The use of SvO2 instead of SvcO2 may lead to changes in clinical management in a small but clinically relevant portion of patients.
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
Conclusions There is a moderate correlation between SvO2 and SvcO2; however, the concordance between them is inadequate. It was not possible to demonstrate that the presence of hypoperfusion alters the concordance between SvO2 and SvcO2. The use of SvO2 instead of SvcO2 may lead to changes in clinical management in a small but clinically relevant portion of patients.
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
LOW-CARDIAC-OUTPUT SYNDROME (LCOS) commonly is encountered after heart, heart-lung, and lung transplantation. Several reasons can be ascribed to LCOS after thoracic organ transplantation, namely suboptimal donor, poor donor management, poor organ preservation, prolong ischemia time, high baseline pulmonary artery pressure in the recipient, old age, comorbid illnesses, and long cardiopulmonary bypass time.1 –6 LCOS prolongs the postoperative recovery, requires higher doses of inotropes, and compromises end-organ perfusion.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Source Type: research
Publication date: December 2016 Source:Best Practice & Research Clinical Anaesthesiology, Volume 30, Issue 4 Author(s): Jan Bakker In this review, the relationship between changes in macrohemodynamics during the development and treatment of acute circulatory failure is discussed in the context of coherence with microcirculation and changes in lactate. In models of circulatory failure, coherence between changes in macrocirculatory and microcirculatory perfusion and coherence with subsequent changes in lactate levels are more or less preserved. However, in patients, particularly those with septic shock, these relationsh...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
(Abstracted from Br J Anaesth, 116:339–349, 2016) The current standard of care for managing patients with severe sepsis and septic shock is aggressive fluid resuscitation, until a central venous pressure of greater than 8 mm Hg is achieved. The rationale behind this approach is to increase a patient’s stroke volume, which in turn improves cardiac output and organ perfusion.
Source: Survey of Anesthesiology - Category: Anesthesiology Tags: Critical Care Source Type: research
In conclusion, in an ovine model of septic shock, administration of HTL was associated with earlier onset impaired tissue perfusion and shorter survival time. These observations raise concerns about use of HTL in septic shock.
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Publication date: Available online 10 November 2016 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Jan Bakker In this review the relationship between changes in macrohemodynamics during the development and treatment of acute circulatory failure will be discussed in the context of coherence with the microcirculation and changes in lactate. It seems that in models of circulatory failure coherence between changes in macrocirculatory perfusion and microcirculatory perfusion and coherence with subsequent changes in lactate levels are more or less preserved. However, in patients, especially those with s...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
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