Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shockReport as inadecuate




Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 20:234

First Online: 02 August 2016Received: 20 May 2016Accepted: 20 July 2016

Abstract

BackgroundPersistent 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.

MethodsEighteen 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.

ResultsDexmedetomidine 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.

ConclusionsDexmedetomidine 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.

KeywordsSeptic shock Lactate Lactate clearance Dexmedetomidine Esmolol  Download fulltext PDF



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