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