SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/34251 http://dx.doi.org/10.1097/SHK.0b013e3182336aa4 |
Resumo: | The pathogenetic mechanisms associated to the beneficial effects of mixed venous oxygen saturation (SvO(2))-guided resuscitation during sepsis are unclear. Our purpose was to evaluate the effects of an algorithm of SvO(2)-driven resuscitation including fluids, norepinephrine and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress during a clinically resembling experimental model of septic shock. Eighteen anesthetized and catheterized pigs (35-45 kg) were submitted to peritonitis by fecal inoculation (0.75 g/kg). After hypotension, antibiotics were administered, and the animals were randomized to two groups: control (n = 9), with hemodynamic support aiming central venous pressure 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg; and SvO(2) (n = 9), with the goals above, plus SvO(2) greater than 65%. the interventions lasted 12 h, and lactated Ringer's and norepinephrine (both groups) and dobutamine (SvO(2) group) were administered. Inflammatory response was evaluated by plasma concentration of cytokines, neutrophil CD14 expression, oxidant generation, and apoptosis. Oxidative stress was evaluated by plasma and myocardial nitrate concentrations, myocardial and vascular NADP(H) oxidase activity, myocardial glutathione content, and nitrotyrosine expression. Mixed venous oxygen saturation-driven resuscitation was associated with improved systolic index, oxygen delivery, and diuresis. Sepsis induced in both groups a significant increase on IL-6 concentrations and plasma nitrate concentrations and a persistent decrease in neutrophil CD14 expression. Apoptosis rate and neutrophil oxidant generation were not different between groups. Treatment strategies did not significantly modify oxidative stress parameters. Thus, an approach aiming SvO(2) during sepsis improves hemodynamics, without any significant effect on inflammatory response and oxidative stress. the beneficial effects associated with this strategy may be related to other mechanisms. |
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Rosario, Andre LoureiroPark, MarceloBrunialti, Milena Karina [UNIFESP]Mendes, Marialice [UNIFESP]Rapozo, Marjorie [UNIFESP]Fernandes, DeniseSalomao, Reinaldo [UNIFESP]Laurindo, Francisco RafaelSchettino, Guilherme PaulaAzevedo, Luciano Cesar P.Hosp Sirio LibanesUniversidade de São Paulo (USP)Universidade Federal de São Paulo (UNIFESP)2016-01-24T14:17:28Z2016-01-24T14:17:28Z2011-12-01Shock. Philadelphia: Lippincott Williams & Wilkins, v. 36, n. 6, p. 604-612, 2011.1073-2322http://repositorio.unifesp.br/handle/11600/34251http://dx.doi.org/10.1097/SHK.0b013e3182336aa410.1097/SHK.0b013e3182336aa4WOS:000297203800012The pathogenetic mechanisms associated to the beneficial effects of mixed venous oxygen saturation (SvO(2))-guided resuscitation during sepsis are unclear. Our purpose was to evaluate the effects of an algorithm of SvO(2)-driven resuscitation including fluids, norepinephrine and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress during a clinically resembling experimental model of septic shock. Eighteen anesthetized and catheterized pigs (35-45 kg) were submitted to peritonitis by fecal inoculation (0.75 g/kg). After hypotension, antibiotics were administered, and the animals were randomized to two groups: control (n = 9), with hemodynamic support aiming central venous pressure 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg; and SvO(2) (n = 9), with the goals above, plus SvO(2) greater than 65%. the interventions lasted 12 h, and lactated Ringer's and norepinephrine (both groups) and dobutamine (SvO(2) group) were administered. Inflammatory response was evaluated by plasma concentration of cytokines, neutrophil CD14 expression, oxidant generation, and apoptosis. Oxidative stress was evaluated by plasma and myocardial nitrate concentrations, myocardial and vascular NADP(H) oxidase activity, myocardial glutathione content, and nitrotyrosine expression. Mixed venous oxygen saturation-driven resuscitation was associated with improved systolic index, oxygen delivery, and diuresis. Sepsis induced in both groups a significant increase on IL-6 concentrations and plasma nitrate concentrations and a persistent decrease in neutrophil CD14 expression. Apoptosis rate and neutrophil oxidant generation were not different between groups. Treatment strategies did not significantly modify oxidative stress parameters. Thus, an approach aiming SvO(2) during sepsis improves hemodynamics, without any significant effect on inflammatory response and oxidative stress. the beneficial effects associated with this strategy may be related to other mechanisms.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Research and Education Institute, Hospital Sirio-Libanes, São Paulo, BrazilHosp Sirio Libanes, Res & Educ Inst, Intens Care & Anesthesiol Lab, BR-01308060 São Paulo, BrazilUniv São Paulo, Dept Emergency Med, São Paulo, BrazilUniversidade Federal de São Paulo, Immunol Lab, Div Infect Dis, São Paulo, BrazilUniv São Paulo, Vasc Biol Lab, Inst Heart, São Paulo, BrazilUniversidade Federal de São Paulo, Immunol Lab, Div Infect Dis, São Paulo, BrazilWeb of Science604-612engLippincott Williams & WilkinsShockSeptic shockmixed venous oxygen saturationhemodynamic resuscitationgoal-directed therapyoxidative stressinflammatory responseSvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESSinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/342512022-02-18 10:14:11.804metadata only accessoai:repositorio.unifesp.br:11600/34251Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:08:08.973748Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
title |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
spellingShingle |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS Rosario, Andre Loureiro Septic shock mixed venous oxygen saturation hemodynamic resuscitation goal-directed therapy oxidative stress inflammatory response |
title_short |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
title_full |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
title_fullStr |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
title_full_unstemmed |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
title_sort |
SvO(2)-GUIDED RESUSCITATION for EXPERIMENTAL SEPTIC SHOCK: EFFECTS of FLUID INFUSION and DOBUTAMINE ON HEMODYNAMICS, INFLAMMATORY RESPONSE, and CARDIOVASCULAR OXIDATIVE STRESS |
author |
Rosario, Andre Loureiro |
author_facet |
Rosario, Andre Loureiro Park, Marcelo Brunialti, Milena Karina [UNIFESP] Mendes, Marialice [UNIFESP] Rapozo, Marjorie [UNIFESP] Fernandes, Denise Salomao, Reinaldo [UNIFESP] Laurindo, Francisco Rafael Schettino, Guilherme Paula Azevedo, Luciano Cesar P. |
author_role |
author |
author2 |
Park, Marcelo Brunialti, Milena Karina [UNIFESP] Mendes, Marialice [UNIFESP] Rapozo, Marjorie [UNIFESP] Fernandes, Denise Salomao, Reinaldo [UNIFESP] Laurindo, Francisco Rafael Schettino, Guilherme Paula Azevedo, Luciano Cesar P. |
author2_role |
author author author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
Hosp Sirio Libanes Universidade de São Paulo (USP) Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Rosario, Andre Loureiro Park, Marcelo Brunialti, Milena Karina [UNIFESP] Mendes, Marialice [UNIFESP] Rapozo, Marjorie [UNIFESP] Fernandes, Denise Salomao, Reinaldo [UNIFESP] Laurindo, Francisco Rafael Schettino, Guilherme Paula Azevedo, Luciano Cesar P. |
dc.subject.eng.fl_str_mv |
Septic shock mixed venous oxygen saturation hemodynamic resuscitation goal-directed therapy oxidative stress inflammatory response |
topic |
Septic shock mixed venous oxygen saturation hemodynamic resuscitation goal-directed therapy oxidative stress inflammatory response |
description |
The pathogenetic mechanisms associated to the beneficial effects of mixed venous oxygen saturation (SvO(2))-guided resuscitation during sepsis are unclear. Our purpose was to evaluate the effects of an algorithm of SvO(2)-driven resuscitation including fluids, norepinephrine and dobutamine on hemodynamics, inflammatory response, and cardiovascular oxidative stress during a clinically resembling experimental model of septic shock. Eighteen anesthetized and catheterized pigs (35-45 kg) were submitted to peritonitis by fecal inoculation (0.75 g/kg). After hypotension, antibiotics were administered, and the animals were randomized to two groups: control (n = 9), with hemodynamic support aiming central venous pressure 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg; and SvO(2) (n = 9), with the goals above, plus SvO(2) greater than 65%. the interventions lasted 12 h, and lactated Ringer's and norepinephrine (both groups) and dobutamine (SvO(2) group) were administered. Inflammatory response was evaluated by plasma concentration of cytokines, neutrophil CD14 expression, oxidant generation, and apoptosis. Oxidative stress was evaluated by plasma and myocardial nitrate concentrations, myocardial and vascular NADP(H) oxidase activity, myocardial glutathione content, and nitrotyrosine expression. Mixed venous oxygen saturation-driven resuscitation was associated with improved systolic index, oxygen delivery, and diuresis. Sepsis induced in both groups a significant increase on IL-6 concentrations and plasma nitrate concentrations and a persistent decrease in neutrophil CD14 expression. Apoptosis rate and neutrophil oxidant generation were not different between groups. Treatment strategies did not significantly modify oxidative stress parameters. Thus, an approach aiming SvO(2) during sepsis improves hemodynamics, without any significant effect on inflammatory response and oxidative stress. the beneficial effects associated with this strategy may be related to other mechanisms. |
publishDate |
2011 |
dc.date.issued.fl_str_mv |
2011-12-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:17:28Z |
dc.date.available.fl_str_mv |
2016-01-24T14:17:28Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Shock. Philadelphia: Lippincott Williams & Wilkins, v. 36, n. 6, p. 604-612, 2011. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/34251 http://dx.doi.org/10.1097/SHK.0b013e3182336aa4 |
dc.identifier.issn.none.fl_str_mv |
1073-2322 |
dc.identifier.doi.none.fl_str_mv |
10.1097/SHK.0b013e3182336aa4 |
dc.identifier.wos.none.fl_str_mv |
WOS:000297203800012 |
identifier_str_mv |
Shock. Philadelphia: Lippincott Williams & Wilkins, v. 36, n. 6, p. 604-612, 2011. 1073-2322 10.1097/SHK.0b013e3182336aa4 WOS:000297203800012 |
url |
http://repositorio.unifesp.br/handle/11600/34251 http://dx.doi.org/10.1097/SHK.0b013e3182336aa4 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Shock |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
604-612 |
dc.publisher.none.fl_str_mv |
Lippincott Williams & Wilkins |
publisher.none.fl_str_mv |
Lippincott Williams & Wilkins |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
|
_version_ |
1783460254122508288 |