Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock

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dc.contributor.authorHernández P., Glenn
dc.contributor.authorTapia, Pablo
dc.contributor.authorAlegría, Leyla
dc.contributor.authorSoto, Dagoberto
dc.contributor.authorJarufe Cassis, Nicolás
dc.contributor.authorAchurra Tirado, Pablo
dc.contributor.authorRebolledo, Rolando
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorCastro, Ricardo
dc.contributor.authorKattan Tala, Eduardo José
dc.contributor.authorBakker, Jan
dc.contributor.authorLuengo, Cecilia
dc.contributor.authorGomez, Jussara
dc.contributor.authorOspina Tascón, Gustavo
dc.date.accessioned2019-10-17T16:01:14Z
dc.date.available2019-10-17T16:01:14Z
dc.date.issued2016
dc.date.updated2019-10-14T19:05:07Z
dc.description.abstractAbstract Background Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock. Methods Eighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experiments. Results Dexmedetomidine and esmolol were hemodynamically well tolerated. The dexmedetomidine group exhibited lower epinephrine levels, but no difference in muscle lactate. Despite progressive hypotension in all groups, both dexmedetomidine and esmolol were associated with lower arterial and portal vein lactate levels. Exogenous lactate clearance was significantly higher in the dexmedetomidine and esmolol groups. Conclusions Dexmedetomidine and esmolol were associated with lower arterial and portal lactate levels, and less impairment of exogenous lactate clearance in a model of septic shock. The use of dexmedetomidine and esmolol appears to be associated with beneficial effects on gut lactate generation and lactate clearance and exhibits no negative impact on systemic hemodynamics.Abstract Background Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock. Methods Eighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experiments. Results Dexmedetomidine and esmolol were hemodynamically well tolerated. The dexmedetomidine group exhibited lower epinephrine levels, but no difference in muscle lactate. Despite progressive hypotension in all groups, both dexmedetomidine and esmolol were associated with lower arterial and portal vein lactate levels. Exogenous lactate clearance was significantly higher in the dexmedetomidine and esmolol groups. Conclusions Dexmedetomidine and esmolol were associated with lower arterial and portal lactate levels, and less impairment of exogenous lactate clearance in a model of septic shock. The use of dexmedetomidine and esmolol appears to be associated with beneficial effects on gut lactate generation and lactate clearance and exhibits no negative impact on systemic hemodynamics.
dc.fuente.origenBiomed Central
dc.identifier.citationCritical Care. 2016 Aug 02;20(1):234
dc.identifier.doi10.1186/s13054-016-1419-x
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/26801
dc.issue.numeroNo. 234
dc.language.isoen
dc.pagina.final10
dc.pagina.inicio1
dc.revistaCritical Carees_ES
dc.rights.holderThe Author(s).
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.otherHiperlipemiaes_ES
dc.subject.otherHemodinámicaes_ES
dc.subject.otherChoque sépticoes_ES
dc.titleEffects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shockes_ES
dc.typeartículo
dc.volumenVol. 20
sipa.codpersvinculados98874
sipa.codpersvinculados104492
sipa.codpersvinculados156236
sipa.codpersvinculados127520
sipa.codpersvinculados741
sipa.codpersvinculados4537
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