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The NO donor SIN‐1 improves intestinal–arterial P co 2 gap in experimental endotoxemia: an animal study
Author(s) -
Siegemund M.,
Van Bommel J.,
Sinaasappel M.,
Schwarte L. A.,
Studer W.,
Girard T.,
Vollebregt K.,
Ince C.
Publication year - 2007
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01334.x
Subject(s) - medicine , shock (circulatory) , resuscitation , microcirculation , hemodynamics , vasodilation , septic shock , oxygenation , mean arterial pressure , anesthesia , sepsis , blood pressure , heart rate
Background: Dysfunction of the microcirculation is a prominent feature of sepsis and endotoxemia. Recently, it has been shown that microcirculatory alterations are completely reversed by local or systemic application of vasodilators in severely septic patients. Therefore, we investigated the influence of vasodilator therapy on microcirculatory dysfunction of the ileum during endotoxic shock in a prospective, controlled animal study. Methods: After baseline measurements, shock was induced in 12 domestic pigs by lipopolysaccharide via the mesenteric vein until the mean arterial pressure fell below 60 mmHg. After 30 min in shock, six animals were resuscitated with either fluid alone (control) or fluid and 2 μg/kg/min of the vasodilator 3‐morpholino‐sydnonimine (SIN‐1). The systemic and regional hemodynamics and oxygenation parameters, tonometric ileal P co 2 and microvascular oxygen pressures (μ P o 2 ) (by oxygen‐dependent Pd‐porphyrin phosphorescence) were measured simultaneously. Results: The ileal–arterial P co 2 gap increased during shock and the ileal mucosal and serosal μ P o 2 decreased concurrently. SIN‐1 in addition to fluid resuscitation significantly improved the ileal–arterial P co 2 gap, whereas fluid alone failed to decrease the P co 2 gap. The SIN‐1‐induced improvement in the P co 2 gap was accompanied by an increase in serosal μ P o 2 above shock levels. Mucosal μ P o 2 was resuscitated to baseline levels in both groups. Conclusion: The application of the vasodilator SIN‐1 in addition to fluid resuscitation improves the ileal–arterial P co 2 gap and mucosal μ P o 2 , together with a moderate increase in serosal μ P o 2 , after endotoxic shock. This finding is consistent with the concept that vasodilators may correct pathologic flow distribution within the intestinal wall.