Limits...
Vasopressin in septic shock: effects on pancreatic, renal, and hepatic blood flow.

Krejci V, Hiltebrand LB, Jakob SM, Takala J, Sigurdsson GH - Crit Care (2007)

Bottom Line: Microcirculatory blood flow decreased in the pancreas by 45% (p < 0.01) and in the kidney by 16% (p < 0.01) but remained unchanged in the liver.Vasopressin caused marked redistribution of splanchnic regional and microcirculatory blood flow, including a significant decrease in portal, pancreatic, and renal blood flows, whereas hepatic artery flow remained virtually unchanged.This study also showed that increased urine output does not necessarily reflect increased renal blood flow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Washington University School of Medicine, Campus Box 8054, St. Louis, MO 63110, USA.

ABSTRACT

Introduction: Vasopressin has been shown to increase blood pressure in catecholamine-resistant septic shock. The aim of this study was to measure the effects of low-dose vasopressin on regional (hepato-splanchnic and renal) and microcirculatory (liver, pancreas, and kidney) blood flow in septic shock.

Methods: Thirty-two pigs were anesthetized, mechanically ventilated, and randomly assigned to one of four groups (n = 8 in each). Group S (sepsis) and group SV (sepsis/vasopressin) were exposed to fecal peritonitis. Group C and group V were non-septic controls. After 240 minutes, both septic groups were resuscitated with intravenous fluids. After 300 minutes, groups V and SV received intravenous vasopressin 0.06 IU/kg per hour. Regional blood flow was measured in the hepatic and renal arteries, the portal vein, and the celiac trunk by means of ultrasonic transit time flowmetry. Microcirculatory blood flow was measured in the liver, kidney, and pancreas by means of laser Doppler flowmetry.

Results: In septic shock, vasopressin markedly decreased blood flow in the portal vein, by 58% after 1 hour and by 45% after 3 hours (p < 0.01), whereas flow remained virtually unchanged in the hepatic artery and increased in the celiac trunk. Microcirculatory blood flow decreased in the pancreas by 45% (p < 0.01) and in the kidney by 16% (p < 0.01) but remained unchanged in the liver.

Conclusion: Vasopressin caused marked redistribution of splanchnic regional and microcirculatory blood flow, including a significant decrease in portal, pancreatic, and renal blood flows, whereas hepatic artery flow remained virtually unchanged. This study also showed that increased urine output does not necessarily reflect increased renal blood flow.

Show MeSH

Related in: MedlinePlus

Microcirculatory blood flow of the liver, the pancreas, and the kidney measured with laser Doppler flowmetry during septic shock. A continuous infusion of vasopressin (0.06 IU/kg per hour) was started at t = 300 minutes in animals in group SV. Animals in group S received intravenous saline only. Results are presented as individual curves. Microcirculatory blood flow is expressed as changes relative to the baseline values (t = 0 minutes). #p < 0.01 compared to t = 300 minutes. Group S, septic control group; group SV, septic test group treated with vasopressin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2246226&req=5

Figure 2: Microcirculatory blood flow of the liver, the pancreas, and the kidney measured with laser Doppler flowmetry during septic shock. A continuous infusion of vasopressin (0.06 IU/kg per hour) was started at t = 300 minutes in animals in group SV. Animals in group S received intravenous saline only. Results are presented as individual curves. Microcirculatory blood flow is expressed as changes relative to the baseline values (t = 0 minutes). #p < 0.01 compared to t = 300 minutes. Group S, septic control group; group SV, septic test group treated with vasopressin.

Mentions: Systemic, regional, and local parameters recorded during the development of septic shock and during fluid resuscitation but before t = 300 minutes are presented in Appendix 1. Data recorded after t = 300 minutes until end of the study at t = 480 minutes are presented below and in Tables 1, 2, 3 and Figures 1 and 2. Three series of LDF measurements from the liver (one each in groups V, S, and SV) and two series from the kidney (one from group C and another from group S) had to be excluded because of excessive motion artifacts and loss of optical coupling to the tissue.


Vasopressin in septic shock: effects on pancreatic, renal, and hepatic blood flow.

Krejci V, Hiltebrand LB, Jakob SM, Takala J, Sigurdsson GH - Crit Care (2007)

Microcirculatory blood flow of the liver, the pancreas, and the kidney measured with laser Doppler flowmetry during septic shock. A continuous infusion of vasopressin (0.06 IU/kg per hour) was started at t = 300 minutes in animals in group SV. Animals in group S received intravenous saline only. Results are presented as individual curves. Microcirculatory blood flow is expressed as changes relative to the baseline values (t = 0 minutes). #p < 0.01 compared to t = 300 minutes. Group S, septic control group; group SV, septic test group treated with vasopressin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2246226&req=5

Figure 2: Microcirculatory blood flow of the liver, the pancreas, and the kidney measured with laser Doppler flowmetry during septic shock. A continuous infusion of vasopressin (0.06 IU/kg per hour) was started at t = 300 minutes in animals in group SV. Animals in group S received intravenous saline only. Results are presented as individual curves. Microcirculatory blood flow is expressed as changes relative to the baseline values (t = 0 minutes). #p < 0.01 compared to t = 300 minutes. Group S, septic control group; group SV, septic test group treated with vasopressin.
Mentions: Systemic, regional, and local parameters recorded during the development of septic shock and during fluid resuscitation but before t = 300 minutes are presented in Appendix 1. Data recorded after t = 300 minutes until end of the study at t = 480 minutes are presented below and in Tables 1, 2, 3 and Figures 1 and 2. Three series of LDF measurements from the liver (one each in groups V, S, and SV) and two series from the kidney (one from group C and another from group S) had to be excluded because of excessive motion artifacts and loss of optical coupling to the tissue.

Bottom Line: Microcirculatory blood flow decreased in the pancreas by 45% (p < 0.01) and in the kidney by 16% (p < 0.01) but remained unchanged in the liver.Vasopressin caused marked redistribution of splanchnic regional and microcirculatory blood flow, including a significant decrease in portal, pancreatic, and renal blood flows, whereas hepatic artery flow remained virtually unchanged.This study also showed that increased urine output does not necessarily reflect increased renal blood flow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Washington University School of Medicine, Campus Box 8054, St. Louis, MO 63110, USA.

ABSTRACT

Introduction: Vasopressin has been shown to increase blood pressure in catecholamine-resistant septic shock. The aim of this study was to measure the effects of low-dose vasopressin on regional (hepato-splanchnic and renal) and microcirculatory (liver, pancreas, and kidney) blood flow in septic shock.

Methods: Thirty-two pigs were anesthetized, mechanically ventilated, and randomly assigned to one of four groups (n = 8 in each). Group S (sepsis) and group SV (sepsis/vasopressin) were exposed to fecal peritonitis. Group C and group V were non-septic controls. After 240 minutes, both septic groups were resuscitated with intravenous fluids. After 300 minutes, groups V and SV received intravenous vasopressin 0.06 IU/kg per hour. Regional blood flow was measured in the hepatic and renal arteries, the portal vein, and the celiac trunk by means of ultrasonic transit time flowmetry. Microcirculatory blood flow was measured in the liver, kidney, and pancreas by means of laser Doppler flowmetry.

Results: In septic shock, vasopressin markedly decreased blood flow in the portal vein, by 58% after 1 hour and by 45% after 3 hours (p < 0.01), whereas flow remained virtually unchanged in the hepatic artery and increased in the celiac trunk. Microcirculatory blood flow decreased in the pancreas by 45% (p < 0.01) and in the kidney by 16% (p < 0.01) but remained unchanged in the liver.

Conclusion: Vasopressin caused marked redistribution of splanchnic regional and microcirculatory blood flow, including a significant decrease in portal, pancreatic, and renal blood flows, whereas hepatic artery flow remained virtually unchanged. This study also showed that increased urine output does not necessarily reflect increased renal blood flow.

Show MeSH
Related in: MedlinePlus