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Abstract
Introduction
Mucosal hypoperfusion during sepsis might impair the epithelial barrier function leading
to translocation of luminal bacterial products and further aggravation of the septic
state. Supporting perfusion of the intestinal mucosa could ameliorate barrier dysfunction.
The microcirculatory effects of hypertonic vs isotonic colloid volume resuscitation
during sepsis have with respect to mucosal perfusion been sparsely reported.
Aim
To evaluate the effects of hypertonic vs. isotonic colloid volume resuscitation to
maintain mucosal perfusion during porcine endotoxemia.
Interventions
Fasted, anesthetised, mechanically ventilated pigs (30.6 ± 2.0 kg, mean ± SEM) received
infusion of LPS (EC seropype 0111: B4) during 2 h to establish septic shock and were
then observed for another 90 min. After 1 h of LPS infusion, animals were randomized
to resuscitation (4 ml/kg for 10 min) with isotonic dextran (Macrodex®, ISO, n = 6
or hypertonic dextran (RescueFlow®, HYPER, n = 6).
Measurements and main results
Mean arterial pressure (MAP), cardiac output (CO), portal venous blood flow (QPV),
mucosal perfusion by laser-Doppler flowmetry (LDF) and tonocapnometry (giving regional
prCO2 and the pCO2 gap from paCO2) were assessed. Statistical analyses were made by
ANOVA. §
P < 0.05 vs. 60 min. *
P < 0.05 vs. ISO.
LPS-infusion resulted in hypodynamic shock after 60 min with no intergroup differences.
Resuscitation with HYPER improved the mesenteric and specifically the mucosal circulation,
whereas ISO was ineffective in this respect. HYPER also tended to improve CO while
this effect failed to gain statistical significance (P = 0.11).
Conclusion
Volume resuscitation with hypertonic colloid proved superior to isotonic colloids
to support intestinal and in particular mucosal perfusion during hypodynamic septic
shock. The results indicate that hypertonic colloids might be of special value to
support mucosal perfusion and thereby possibly barrier function in sepsis.
Table
Baseline
60 min
120 min
180min
210 min
MAP
HYPER
96 ± 10
54 ± 7
43 ± 3§
44 ± 5
38 ± 6§
ISO
109 ± 4
56 ± 7
45 ± 9§
35 ± 10§
35 ± 9§
CO
HYPER
4.6 ± 0.5
3.2 ± 0.4
3.5 ± 0.4
3.4 ± 0.5
2.8 ± 0.7
ISO
44.8 ± 0.4
3.0 ± 0.3
3.2 ± 0.4
2.1 ± 0.4
1.3 ± 0.5
QPV
HYPER
958 ± 49
916 ± 147
1143 ± 326§
1152 ± 164§
972 ± 258*
ISO
946 ± 76
882 ± 145
1082 ± 248§
698 ± 146
283 ± 152
LDF
HYPER
268 ± 48
220 ± 25
255± 41
234 ± 28
194 ± 12*
ISO
248 ± 18
177 ± 14
185± 34
153 ± 25
103 ± 18§
TONO
HYPER
1.6 ± 0.6
2.9 ± 1.1
2.9 ± 0.9
3.9 ± 1.0
4.1 ± 0.9*
ISO
1.4 ± 0.6
2.6 ± 0.6
3.5 ± 1.3
5.5 ± 1.0§
8.3 ± 0.5§