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Title Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows
Creator/Author Bersten, A.D. ; Gnidec, A.A. ; Rutledge, F.S. ; Sibbald, W.J. (Univ. of Western Ontario, London (Canada))
Publication Date1990 May 01
OSTI IdentifierOSTI ID: 6725102
Other Number(s)ISSN0003-0805; CODEN: ARDSB
Resource TypeJournal Article
Resource RelationAmerican Review of Respiratory Disease (New York) ; Vol/Issue: 141
Subject550901 -- Pathology-- Tracer Techniques; BACTERIAL DISEASES-- PATHOGENESIS;ORGANS-- BLOOD FLOW; DEUTERIUM;MICROSPHERES;RESPIRATION;SHEEP;TRACER TECHNIQUES
Related SubjectANIMALS;BODY;DISEASES;DOMESTIC ANIMALS;HYDROGEN ISOTOPES;INFECTIOUS DISEASES;ISOTOPE APPLICATIONS;ISOTOPES;LIGHT NUCLEI;MAMMALS;NUCLEI;ODD-ODD NUCLEI;RUMINANTS;STABLE ISOTOPES;VERTEBRATES
Description/Abstract Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep.^During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected.^Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius.^Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) and systemic O2 delivery when compared with the nonseptic study, whereas whole-body O2 extraction was depressed.^Although PEEP depressed systemic Q during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen.^Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study.^When an infusion of Ringer`s lactate subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored.^Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study.^We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations.^However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2.
Country of PublicationUnited States
LanguageEnglish
FormatPages: 1198-1208
System Entry Date2001 May 13

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