Authors: Karl Träger Martin Matejovic Carl Zülke Arnim Vlatten Josef Vogt Ulrich Wachter Jürgen Altherr Alexander Brinkmann Karl W Jauch Michael Georgieff Peter Radermacher
Publish Date: 2014/04/11
Volume: 26, Issue: 10, Pages: 1531-1539
Abstract
Objective To compare the effects of a 12 h continuous infusion of iloprost a stable prostacyclin analogue on hepatic blood flow Qliv O2 exchange and energy metabolism during a 24 h hyperdynamic porcine endotoxemia with volume resuscitation alone Design Prospective randomized experimental study with repeated measures Setting Investigational animal laboratory Subjects Twentyeight domestic pigs 16 animals during endotoxemia with volume resuscitation alone ETX 12 with endotoxemia volume resuscitation and treatment with iloprost ILO Interventions Endotoxemia was initiated by continuous infusion of E coli lipopolysaccharide Animals were resuscitated with hetastarch aimed at maintaining a MAP of 60 mmHg After 12 h of endotoxemia iloprost was administered for 12 h in the treatment group titrated to avoid pharmacologically induced hypotension MAP 60 mmHg Measurements and results Iloprost significantly increased Qliv with no effect on hepatic O2 delivery Mean capillary hemoglobin O2 saturation HbScO2 on the liver surface as well as HbScO2 frequency distributions – a measure of microcirculatory O2 availability – remained unchanged Treatment with iloprost however significantly attenuated the endotoxininduced derangements of cellular energy metabolism as reflected by the diminished progressive decrease in hepatic lactate uptake rate and a blunted increase in hepatic venous lactate/pyruvate ratios While endotoxin significantly increased endogenous glucose production EGP rate iloprost restored EGP to normal at the end of the experiment Conclusions Thus in a clinically relevant model of human sepsis iloprost did not produce potential adverse effects but rather ameliorated hepatic metabolic disturbances and thereby hepatic energy balance
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