scholarly journals Hemodynamic and anti-inflammatory effects of early esmolol use in hyperkinetic septic shock: a pilot study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Bruno Levy ◽  
Caroline Fritz ◽  
Caroline Piona ◽  
Kevin Duarte ◽  
Andrea Morelli ◽  
...  
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Cardiac Index ◽  
Arterial Pressure ◽  
Beta Blockers ◽  
Venous Pressure ◽  
Venous Blood ◽  
Blood Gases ◽  
Systolic Arterial Pressure ◽  
Increased Risk

Abstract Background Several studies have shown that heart rate control with selective beta-1 blockers in septic shock is safe. In these trials, esmolol was administered 24 h after onset of septic shock in patients who remained tachycardic. While an earlier use of beta-blockers might be beneficial, such use remains challenging due to the difficulty in distinguishing between compensatory and non-compensatory tachycardia. Therefore, the Esmosepsis study was designed to study the effects of esmolol aimed at reducing the heart rate by 20% after the initial resuscitation process in hyperkinetic septic shock patients on (1) cardiac index and (2) systemic and regional hemodynamics as well as inflammatory patterns. Methods Nine consecutive stabilized tachycardic hyperkinetic septic shock patients treated with norepinephrine for a minimum of 6 h were included. Esmolol was infused during 6 h in order to decrease the heart rate by 20%. The following data were recorded at hours H0 (before esmolol administration), H1–H6 (esmolol administration) and 1 h after esmolol cessation (H7): systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure, heart rate, PICCO transpulmonary thermodilution, sublingual and musculo-cutaneous microcirculation, indocyanine green clearance and echocardiographic parameters, diuresis, lactate, and arterial and venous blood gases. Results Esmolol was infused 9 (6.4–11.6) hours after norepinephrine introduction. Esmolol was ceased early in 3 out of 9 patients due to a marked increase in norepinephrine requirement associated with a picture of persistent cardiac failure at the lowest esmolol dose. For the global group, during esmolol infusion, norepinephrine infusion increased from 0.49 (0.34–0.83) to 0.78 (0.3–1.11) µg/min/kg. The use of esmolol was associated with a significant decrease in heart rate from 115 (110–125) to 100 (92–103) beats/min and a decrease in cardiac index from 4.2 (3.1–4.4) to 2.9 (2.5–3.7) l/min/m−2. Indexed stroke volume remained unchanged. Cardiac function index and global ejection fraction also markedly decreased. Using echocardiography, systolic, diastolic as well as left and right ventricular function parameters worsened. After esmolol cessation, all parameters returned to baseline values. Lactate and microcirculatory parameters did not change while the majority of pro-inflammatory proteins decreased in all patients. Conclusion In the very early phase of septic shock, heart rate reduction using fast esmolol titration is associated with an increased risk of hypotension and decreased cardiac index despite maintained adequate tissue perfusion (NCT02068287).

Profound Increase in Epinephrine Concentration in Plasma and Cardiovascular Stimulation after [micro sign]-Opioid Receptor Blockade in Opioid-addicted Patients during Barbiturate-induced Anesthesia for Acute Detoxification 

1998 ◽  
Vol 88 (5) ◽  
pp. 1154-1161 ◽  
Author(s):  
Peter Kienbaum ◽  
Norbert Thurauf ◽  
Martin C. Michel ◽  
Norbert Scherbaum ◽  
Markus Gastpar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Index ◽  
Arterial Pressure ◽  
Opioid Receptor ◽  
Resistance Index ◽  
Systolic Arterial Pressure ◽  
Mu Opioid Receptor ◽  
Receptor Blockade ◽  
Mu Opioid ◽  
A Minor

Background Acute displacement of opioids from their receptors by administration of large doses of opioid antagonists during general anesthesia is a new approach for detoxification of patients addicted to opioids. The authors tested the hypothesis that mu-opioid receptor blockade by naloxone induces cardiovascular stimulation mediated by the sympathoadrenal system. Methods Heart rate, cardiac index, and intravascular pressures were measured in 10 patients addicted to opioids (drug history; mean +/- SD, 71 +/- 51 months) during a program of methadone substitution (96 +/- 57 mg/day). Cardiovascular variables and concentrations of catecholamine in plasma were measured in the awake state, during methohexital-induced anesthesia (dose, 74 +/- 44 microg x kg(-1) x min(-1)) before administration of naloxone, and repeatedly during the first 3 h of mu-opioid receptor blockade. Naloxone was administered initially in an intravenous dose of 0.4 mg, followed by incremental bolus doses (0.8, 1.6, 3.2, and 6.4 mg) at 15-min intervals until a total dose of 12.4 mg had been administered within 60 min; administration was then continued by infusion (0.8 mg/h). Results Concentration of epinephrine in plasma increased 30-fold (15 +/- 9 to 458 +/- 304 pg/ml), whereas concentration of norepinephrine in plasma only increased to a minor extent (76 +/- 44 to 226 +/- 58 pg/ml, P < 0.05). Cardiac index increased by 74% (2.7 +/- 0.41 to 4.7 +/- 1.7 min(-1) x m(-2)), because of increases in heart rate (89 +/- 16 to 108 +/- 17 beats/min) and stroke volume (+44%), reaching maximum 45 min after the initial injection of naloxone. In parallel, systemic vascular resistance index decreased (-40%). Systolic arterial pressure significantly increased (113 +/- 16 to 138 +/- 16 mmHg), whereas diastolic arterial pressure did not change. Conclusions Despite barbiturate-induced anesthesia, acute mu-opioid receptor blockade in patients addicted to opioids induces profound epinephrine release and cardiovascular stimulation. These data suggest that long-term opioid receptor stimulation changes sympathoadrenal and cardiovascular function, which is acutely unmasked by mu-opioid receptor blockade. Because of the attendant cardiovascular stimulation, acute detoxification using naloxone should be performed by trained anesthesiologists or intensivists.

Diagnostic Validity of Ratio between Differences of Central Venous to Arterial CO2 and Arterial to Central Venous O2 Content in Diagnosis of Anaerobic Metabolism among Septic Patients

2021 ◽  
Vol 8 (1) ◽  
pp. 34-38
Author(s):  
Subroto Kumar Sarker ◽  
Umme Kulsum Choudhury ◽  
Mohammad Mohsin ◽  
Subrata Kumar Mondal ◽  
Muslema Begum
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Anaerobic Metabolism ◽  
Venous Blood ◽  
Blood Gases ◽  
Serum Lactate ◽  
Central Venous ◽  
College Hospital ◽  
Sepsis And Septic Shock

Background: Detection of anaerobic metabolism is very crucial for the management of the septic patients. Objective: The purpose of the present study was to validate the ratio between differences of central venous to arterial CO2 and arterial to central venous O2 content in diagnosis of anaerobic metabolism among septic patients. Methodology: This prospective observational study was conducted in the Intensive Care Unit of the department of Anaesthesia Analgesia, Palliative and Intensive Care Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to December 2016. All patients admitted to ICU with the features of severe sepsis and septic shock according to SSC guidelines with the age of more than or equal to 18 years in both sexes were included in this study. The arterial and central venous blood gases were measure simultaneously. At the same time serum lactate was measured. Result: Among the 69 patients, 31(44.9%) were of severe sepsis and 38(55%) were of septic shock patients. In the severe sepsis and septic shock patients the mean P(v-a)CO2/C(a-v)O2 is 1.39±0.41 and 1.11±0.40 respectively. Serum lactate in case of severe sepsis and septic shock patients is 2.85±1.40 and 3.85±1.04 respectively. The ROC analysis showed an area under curve 0.89 and P(v-a)CO2/C(a-v)O2 ratio cutoff value of 1.21 showed sensitivity 0.84 and specificity 0.94. Conclusion: The P(v-a)CO2/C(a-v)O2  ratio is also a another marker of global anaerobic metabolism and it would be used for diagnosis as well as management of septic patient.  Journal of Current and Advance Medical Research, January 2021;8(1):34-38

Comparison of phenylephrine bolus and infusion methods in baroreflex measurements

1990 ◽  
Vol 69 (3) ◽  
pp. 962-967 ◽  
Author(s):  
J. T. Sullebarger ◽  
C. S. Liang ◽  
P. D. Woolf ◽  
A. E. Willick ◽  
J. F. Richeson
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Baroreflex Sensitivity ◽  
Heart Rate Response ◽  
Pressor Response ◽  
Plasma Catecholamines ◽  
Systolic Arterial Pressure ◽  
Normal Subjects ◽  
Vagus Nerves ◽  
Baroreflex Control

Phenylephrine (PE) bolus and infusion methods have both been used to measure baroreflex sensitivity in humans. To determine whether the two methods produce the same values of baroreceptor sensitivity, we administered intravenous PE by both bolus injection and graded infusion methods to 17 normal subjects. Baroreflex sensitivity was determined from the slope of the linear relationship between the cardiac cycle length (R-R interval) and systolic arterial pressure. Both methods produced similar peak increases in arterial pressure and reproducible results of baroreflex sensitivity in the same subjects, but baroreflex slopes measured by the infusion method (9.9 +/- 0.7 ms/mmHg) were significantly lower than those measured by the bolus method (22.5 +/- 1.8 ms/mmHg, P less than 0.0001). Pretreatment with atropine abolished the heart rate response to PE given by both methods, whereas plasma catecholamines were affected by neither method of PE administration. Naloxone pretreatment exaggerated the pressor response to PE and increased plasma beta-endorphin response to PE infusion but had no effect on baroreflex sensitivity. Thus our results indicate that 1) activation of the baroreflex by the PE bolus and infusion methods, although reproducible, is not equivalent, 2) baroreflex-induced heart rate response to a gradual increase in pressure is less than that seen with a rapid rise, 3) in both methods, heart rate response is mediated by the vagus nerves, and 4) neither the sympathetic nervous system nor the endogenous opiate system has a significant role in mediating the baroreflex control of heart rate to a hypertensive stimulus in normal subjects.

scholarly journals Sex differences in blood pressure responsiveness to spontaneous K-complexes during stage II sleep

2020 ◽  
Author(s):  
Ian Mark Greenlund ◽  
Carl A. Smoot ◽  
Jason R. Carter
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Pressure ◽  
Cardiac Cycle ◽  
Pressor Response ◽  
Systolic Arterial Pressure ◽  
Stage Ii ◽  
Men And Women ◽  
Blood Pressures ◽  
Blood Pressure Responses

K-complexes are a key marker of non-rapid eye movement sleep (NREM), specifically during stages II sleep. Recent evidence suggests the heart rate responses to a K-complexes may differ between men and women. The purpose of this study was to compare beat-to-beat blood pressure responses to K-complexes in men and women. We hypothesized that the pressor response following a spontaneous K-complex would be augmented in men compared to women. Ten men (Age: 23 ± 2 years, BMI: 28 ± 4 kg/m2) and ten women (Age: 23 ± 5 years, BMI: 25 ± 4 kg/m2) were equipped with overnight finger plethysmography and standard 10-lead polysomnography. Hemodynamic responses to a spontaneous K-complex during stable stage II sleep were quantified for 10 consecutive cardiac cycles, and measurements included systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate. K-complex elicited greater pressor responses in men when blood pressures were expressed as SAP (cardiac cycle × sex: p = 0.007) and DAP (cardiac cycle × sex: p = 0.004). Heart rate trended to be different between men and women (cardiac cycle × sex: p = 0.078). These findings suggest a divergent pressor response between men and women following a spontaneous K-complex during normal stage II sleep. These findings could contribute to sex-specific differences in cardiovascular risk that exist between men and women.

Mesenteric Blood Flow as Influenced by Progressive Hypercapnia

1956 ◽  
Vol 184 (2) ◽  
pp. 275-281 ◽  
Author(s):  
Eugene W. Brickner ◽  
E. Grant Dowds ◽  
Bruce Willitts ◽  
Ewald E. Selkurt
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Arterial Pressure ◽  
Oxygen Content ◽  
Vascular Resistance ◽  
Pulse Pressure ◽  
Venous Pressure ◽  
Mesenteric Blood Flow ◽  
Initial Tendency ◽  
Elevated Heart Rate

The influence of hypercapnia on mesenteric blood flow was studied in dogs subjected to progressive increments in CO2 content of inspired air produced by rebreathing from a large spirometer. Oxygen content was maintained above 21 volumes %. Although some animals showed an initial tendency for mesenteric blood flow to decrease and arterial pressure to increase in the range 0–5 volumes % of CO2, the usual hemodynamic change in the range 5–16 volumes % was an increase in mesenteric blood flow resulting from decrease in intestinal vascular resistance, accompanied by a decline in arterial pressure. Portal venous pressure was progressively elevated. Heart rate slowed in association with an increase in pulse pressure. The observations suggest that in higher ranges of hypercapnia, CO2 has a direct dilating action on the mesenteric vasculature.

Effect of a transient displacement of blood toward the heart on the pulse rate

1965 ◽  
Vol 20 (6) ◽  
pp. 1153-1156
Author(s):  
Roger L. Walker ◽  
Ian F. S. Mackay
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Pulse Rate ◽  
Venous Return ◽  
Human Subjects ◽  
Venous Pressure ◽  
Right Heart ◽  
Sudden Release

Sudden release of venous congesting cuffs in human subjects may cause a tachycardia. Among the factors that may be responsible for this increase in heart rate are a) a fall in arterial pressure, b) the hyperpnea that follows the cuff release, and c) an increase in “venous return.” A technique was designed which excluded the first two of these factors and, under the conditions of this technique, a demonstrable transient displacement of blood toward the heart with an associated rise in venous pressure but no change in arterial pressure did not cause cardiac acceleration. The presence of a “Bainbridge” type of reflex in man is questioned. Bainbridge reflex; cardiac reflexes in man; right heart filling Submitted on September 28, 1964

scholarly journals A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension during Subarachnoid Anaesthesia in the Elderly

1998 ◽  
Vol 26 (5) ◽  
pp. 497-502 ◽  
Author(s):  
J. C. M. Yap ◽  
L. A. H. Critchley ◽  
S. C. Yu ◽  
R. M. Calcroft ◽  
J. L. Derrick
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Pressure ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Normal Saline ◽  
Computer Software ◽  
Systolic Arterial Pressure ◽  
The Elderly ◽  
Group A

We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure <75% of baseline, was prevented or treated by: A—normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B—normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C—Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P<0.001). Decreases were greatest in group A (P<0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P<0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.

Effects of intravenous terbutaline on heart rate, arterial pressure and blood gases in anesthetized horses breathing air

2017 ◽  
Vol 44 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Isla Arcaro ◽  
Berit L. Fischer ◽  
Kara M. Lascola ◽  
Stuart C. Clark-Price
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Blood Gases

Cardiopulmonary Effects of Intrathoracic Insufflation in Dogs

2002 ◽  
Vol 38 (6) ◽  
pp. 515-520 ◽  
Author(s):  
Curt M. Daly ◽  
Karen Swalec-Tobias ◽  
Anthony H. Tobias ◽  
Nicole Ehrhart
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Arterial Pressure ◽  
Healthy Adult ◽  
Venous Pressure ◽  
Minute Volume ◽  
Mechanical Ventilator ◽  
Central Venous ◽  
Anesthetized Dogs ◽  
Pressure Standard

This study was designed to quantify the effects of incremental positive insufflation of the intrathoracic space on cardiac output (CO), heart rate (HR), arterial pressure (AP), central venous pressure (CVP), and percent saturation of hemoglobin with oxygen (SPO2) in anesthetized dogs. Seven healthy, adult dogs from terminal teaching laboratories were maintained under anesthesia with isoflurane delivered with a mechanical ventilator. The experimental variables were recorded before introduction of an intrathoracic catheter, at intrathoracic pressures (IP) of 0 mm Hg, 3 mm Hg insufflation, and additional increments of 1 mm Hg insufflation thereafter until the SPO2 remained &lt;85% despite increases in minute volume. Finally the variables were measured again at 0 mm Hg IP. The cardiac output and systolic and diastolic AP significantly (P&lt;0.05) decreased at 3 mm Hg IP. Significant decreases in SPO2 were seen at 10 mm Hg IP. Significant increase in CVP was noted at 6 mm Hg IP. Heart rate decreased significantly at 5 to 6 mm Hg IP but was not decreased above 6 mm Hg IP. Given the degree of CO decrease at low intrathoracic pressures, insufflation-aided thoracoscopy should be used with caution and at the lowest possible insufflation pressure. Standard anesthetic monitoring variables such as HR and AP measurements may not accurately reflect the animal’s cardiovascular status.

Plasma arginine vasopressin during neck suction in upright sitting man

1987 ◽  
Vol 114 (2) ◽  
pp. 243-248 ◽  
Author(s):  
P. Norsk ◽  
F. Bonde-Petersen ◽  
J. Warberg
Keyword(s):  
Arterial Pressure ◽  
Arginine Vasopressin ◽  
Venous Pressure ◽  
Haemoglobin Concentration ◽  
Plasma Osmolality ◽  
Systolic Arterial Pressure ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Vasopressin Secretion ◽  
Plasma Arginine

Abstract. In order to examine the influence of carotid baroreceptor stimulation on arginine vasopressin secretion, 8 normal healthy males were subjected to static neck suction of −3.3 kPa for 20 min in the upright sitting position after overnight food and fluid restriction. The plasma concentration of arginine vasopressin did not change significantly during neck suction. However, in 3 subjects the termination of neck suction induced large increases in plasma arginine vasopressin from 1.8 to 63.7 ng/l, from 0.7 to 34.3 ng/l and from 2.1 to 19.0 ng/l, respectively. Two subjects experienced symptoms such as nausea and paleness during neck suction. Systolic arterial pressure increased slightly but significantly during neck suction from 15.3 ± 0.3 to 15.7 ± 0.4 kPa (N = 7, P < 0.05), whereas mean arterial pressure, diastolic arterial pressure, central venous pressure, heart rate, plasma osmolality, plasma sodium and potassium were unchanged. Haemoglobin concentration in blood and haematocrit increased significantly during and after neck suction, whereas plasma volume decreased. We conclude that neck suction with a negative pressure of 3.3 kPa in upright sitting man does not significantly affect plasma arginine vasopressin. However, termination of the stimulation induces large increases in some subjects. This may be explained by a direct effect on the vagus nerve or by a selective deloading of carotid baroreceptors.

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