Skip to content

Advertisement

  • Meeting abstract
  • Open Access

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

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20004 (Suppl 1) :P46

https://doi.org/10.1186/cc766

  • Published:

Keywords

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

Full text

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.

(median/percentile)

Baseline

Iloprost

Baseline

Sys. DO2 ml/min/m2

565/642-473

634/699-513

524/651-472

Sys. VO2 ml/min/m2

139/142-131

147/164-136 *

143/154-133

Spl. DO2 ml/min/m 2

122/166-103

134/203-117 *

130/158-98

Spl. VO2 ml/min/m 2

58/67-49

59/71-57

56/65-52

Spl. Lactate balance μmol/kg/min

12/13-4

13/14-2

11/13-5

Glucose production μmol/kg/min

16/ 19-14

11/15-9 *

11/11-8

Hv. Lactate/pyruvate

18/21-16

16/34-12

13/22-12

Hv. Acetoacetate/β-OH-butyrate

0.21/0.59-0.13

0.22/0.45-0.08

0.22/0.34-0.05

Declarations

Acknowledgement

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

Authors’ Affiliations

(1)
Universitätsklinik f. Anästhesiologie, Universität, D-89070 Ulm, Germany

References

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

Copyright

Advertisement