Volume 2 Supplement 1

18th International Symposium on Intensive Care and Emergency Medicine

Open Access

Hepatic O2 transport and energy balance in hyperdynamic porcine endotoxin shock: NG-monornethyl-L-arginine (L-NMMA) versus noradrenaline

  • KM Rieger1,
  • K Träger1,
  • A Vlatten1,
  • M Matejovic1,
  • T Iber1,
  • M Georgieff1 and
  • P Radermacher1
Critical Care19982(Suppl 1):P140

DOI: 10.1186/cc269

Published: 1 March 1998

Introduction

Nitric oxide synthase (NOS) inhibition is currently investigated as a treatment of arterial hypotension associated with septic shock, but controversial data are available with respect to hepatic O2 balance. Therefore we studied the effect of NOS inhibition with L-NMMA on liver O2 transport as well as energy balance, in comparison to a standard treatment with noradrenaline (NOR) in a hyperdynamic endotoxin (ETX) shock model.

Methods

Thirty anesthetized pigs were randomly assigned to 3 groups 12 h after induction of endotoxic shock with continuous LPS infusion: ETX group: no drug therapy (n = 8); NOR group (n = 11) and L-NMMA group (n = 11): vasopressor therapy with NOR and L-NMMA was titrated to maintain MAP at preshock levels. Hepatic blood flow (Transonic® Doppler ultrasound), O2 kinetics as well as mean and frequency distribution of intracapillary HbO2 saturation (remission spectrophotometry, EMPHO) were measured.

Results

Data are median and interquartile range. *P < 0.05 vs preshock (RM ANOVA on ranks). **P < 0.05 between groups (ANOVA).

Conclusions

Although, in contrast to NOR, L-NMMA did notfurther increase macrocirculatory liver O2 availability, there was no difference between the two treatments with regard to microcircula-tory O2 supply and O2 uptake. Hence, neither of the two treatments improved liver energy balance.

Table

  

Preshock

12 h

18 h

24 h

Liver DO2

ETX

2.3 [1.9;2.8]

2.2 [1.7;2.7]

2.7 [2.0;3.0]

2.0 [1.4;2.6]

ml/min/kg

NOR*

2.3 [1.8;2.8]

2.0 [1.5;2.4]

3.1 [2.8;3.6**

2.6 [1.9;4.1]

 

L-NMMA

2.5 [2.2; 2.9]

2.5 [2.1 ;2.61

2.3 [1.7;2.8]

2.0 [1.1;2.6]

Hepatic

ETX

54 ± 5

51 ± 7

51 ± 7

47 ± 10

intracap. HbO2

NOR

59 ± 6

54 ± 8

61 ± 7

58 ± 12

Mean ± SD

L-NMMA

59 ± 8

56 ± 10

55 ± 10

58 ± 7

Liver VO2

ETX

0.7 [0.5;1.1]

0.6 [0.4;0.8]

0.6 [0.4;0.8]

0.6 [0.3;0.7]

ml/min/kg

NOR

0.7 [0.5;1.1]

0.6 [0.4;0.8]

0.6 [0.4;0.8]

0.6 [0.3;0.7]

 

L-NMMA

0.8 [0.5;0.8]

0.8 [0.5;1.0]

0.6 [0.4;0.8]

0.5 [0.3;0.8]

Hepatic

ETX*

7.48 [17.46;7.50]

7.38 [7.34;7.42]

7.36 [7.34;7.381

7.30 [7.25;7.34]

venous pH

NOR*

7.49 [7.46;7.51]

7.33 [7.25;7.34]

7.32 [7.2817.371

7.22 [7.17;7.37]

 

L-NMMA*

7.48 [7.44,7.49]

7.32 [7.31 ;7.341

7.29 [7.26;7.321

7.24 [7.16;7.30]

Hepatic

ETX*

24 [15;32]

26 [18;30]

34 [28;51]

61 [31;123]

venous Lac/Pyr

NOR*

31 [21;37]

38 [25;66]

95 [49;1 01]

104 [41 ;204]

ratio

L-NMMA*

21 [18;29]

28 [28;50]

60 [40;95]

148 [67;187]

Declarations

Acknowledgement

L-NMMA (546C88) was kindly provided by GlaxoWellcome, UK.

Authors’ Affiliations

(1)
Sektion APV, Universitätsklinik füur Anästhesiologie

Copyright

© Current Science Ltd 1998

Advertisement