| Title |
Effects of early hemodynamic resuscitation on left ventricular performance and microcirculatory function during endotoxic shock
|
|---|---|
| Published in |
Intensive Care Medicine Experimental, May 2015
|
| DOI | 10.1186/s40635-015-0049-y |
| Pubmed ID | |
| Authors |
Alejandra López, Juan Carlos Grignola, Martín Angulo, Ignacio Alvez, Nicolás Nin, Gonzalo Lacuesta, Manuel Baz, Pablo Cardinal, Ivana Prestes, Juan P Bouchacourt, Juan Riva, Can Ince, Francisco Javier Hurtado |
| Abstract |
Microcirculation and macrohemodynamics are severely compromised during septic shock. However, the relationship between these two compartments needs to be further investigated. We hypothesized that early resuscitation restores left ventricular (LV) performance and microcirculatory function but fails to prevent metabolic disorders. We studied the effects of an early resuscitation protocol (ERP) on LV pressure/volume loops-derived parameters, sublingual microcirculation, and metabolic alterations during endotoxic shock. Twenty-five pigs were randomized into three groups: LPS group: Escherichia coli lipopolysaccharide (LPS); ERP group: LPS + ERP based on volume expansion, dobutamine, and noradrenaline infusion; Sham group. LV pressure/volume-derived parameters, systemic hemodynamics, sublingual microcirculation, and metabolic profile were assessed at baseline and after completing the resuscitation protocol. LPS significantly decreased LV end-diastolic volume, myocardial contractility, stroke work, and cardiac index (CI). Early resuscitation preserved preload, and myocardial contractility, increased CI and heart rate (p < .05). LPS severely diminished sublingual microvascular flow index (MFI), perfused vascular density (PVD), and the proportion of perfused vessels (PPV), while increased the heterogeneity flow index (HFI) (p < .05). Despite MFI was relatively preserved, MVD, PVD, and HFI were significantly impaired after resuscitation (p < .05). The macro- and microcirculatory changes were associated with increased lactic acidosis and mixed venous O2 saturation when compared to baseline values (p < .05). The scatter plot between mean arterial pressure (MAP) and MFI showed a biphasic relationship, suggesting that the values were within the limits of microvascular autoregulation when MAP was above 71 ± 6 mm Hg (R (2) = 0.63). Early hemodynamic resuscitation was effective to restore macrohemodynamia and myocardial contractility. Despite MAP and MFI were relatively preserved, the persistent microvascular dysfunction could explain metabolic disorders. The relationship between micro- and systemic hemodynamia and their impact on cellular function and metabolism needs to be further studied during endotoxic shock. |
X Demographics
The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 33% |
| Belgium | 1 | 33% |
| Unknown | 1 | 33% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 33% |
| Members of the public | 1 | 33% |
| Science communicators (journalists, bloggers, editors) | 1 | 33% |
Mendeley readers
The data shown below were compiled from readership statistics for 30 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Uruguay | 1 | 3% |
| Unknown | 29 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 3 | 10% |
| Student > Ph. D. Student | 3 | 10% |
| Student > Doctoral Student | 3 | 10% |
| Professor | 3 | 10% |
| Student > Bachelor | 3 | 10% |
| Other | 8 | 27% |
| Unknown | 7 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 16 | 53% |
| Immunology and Microbiology | 2 | 7% |
| Agricultural and Biological Sciences | 2 | 7% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Business, Management and Accounting | 1 | 3% |
| Other | 1 | 3% |
| Unknown | 7 | 23% |
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 November 2015.
All research outputs
#13,449,870
of 22,831,537 outputs
Outputs from Intensive Care Medicine Experimental
#221
of 446 outputs
Outputs of similar age
#127,271
of 264,471 outputs
Outputs of similar age from Intensive Care Medicine Experimental
#4
of 6 outputs
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