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Influence of iloprost on hepato splanchnic metabolic activity and energy balance in patients with septic shock

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Introduction

Septic shock is characterized by increased splanchnic blood flow due to enhanced metabolic activity. Endogenous prostacyclin may be crucial to maintain liver function and gastric mucosal integrity [1]. Therefore we studied the effect of intravenous. iloprost on hepatosplanchnic metabolic activity and energy balance in patients with septic shock.

Patients/methods

Twelve patients with septic shock (cardiac index, CI ≥ 3 l/min×m2, all requiring noradrenaline≥ 0.03 μg/kg×min-1 to maintain mean arterial pressure (MAP ≥ 70 mmHg) were studied. In addition to routine systemic hemodynamics and gas exchange we inserted a Swan Ganz catheter into a hepatic vein (hv) to measure splanchnic blood flow using primed continuous infusion of indocyanine-green. Moreover, we assessed splanchnic lactate uptake (Fick principle), endogenous glucose production rate (stable isotope approach), as well as hepatic venous lactate/pyruvate and acetoacetate/β-OH-butyrate ratios. Measurements obtained after 90' of hemodynamic steady-state were recorded before, after and during iloprost infusion titrated to obtain a 20% increase in CI (0.9–3 ng/kg×min-1).

Results/statistics

See Table. Friedmann test/Student-Newman-Keuls: *P<0.05 vs baseline.

Conclusion

While maintaining hepato-splanchnic lactate clearance, iloprost reduced the endogenous glucose production rate, hence the hepatic O2 requirements. The unchanged regional O2 uptake therefore suggests shifting of O2 consumption to other energy demanding processes.

Table 1

References

  1. 1.

    Brinkmann A, et al.: . Crit Care Med 1996, 24: 1293-1301. 10.1097/00003246-199608000-00005

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Acknowledgement

Supported by Deutsche Forschungsgemeinschaft (Ra 396/4-1); Schering - Germany

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Kiefer, P., Tugtekin, I., Bracht, H. et al. Influence of iloprost on hepato splanchnic metabolic activity and energy balance in patients with septic shock. Crit Care 4, P46 (2000). https://doi.org/10.1186/cc766

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Keywords

  • Septic Shock
  • Prostacyclin
  • Acetoacetate
  • Iloprost
  • Lactate Clearance