Abstract
A case of ascending cholangitis with sepsis where a combination of flurbiprofen axetil and dobutamine improved tissue oxygen metabolism is reported. A 23-year-old man was admitted to our hospital with a diagnosis of ascending cholangitis. He had a history of hepatic porto-enterostomy for biliary atresia at 90 days after birth. The patient fell into respiratory failure with sepsis one day after admission and was transfered to our ICU. Mechanical ventilation via tracheal tube was performed. Hemodynamic values including an elevated heart rate (128min-1) and cardiac index (7.8l·min-1·m-2) indicated a hyperdynamic state, but oxygen uptake decreased with a lowered oxygen extraction ratio (13%) and elevated mixed venous oxygen saturation (89.3%). Severe lactic acidosis (lactate 9.8mg·dl-1) occurred, indicating that oxygen debt induced hypoxic tissue injury. Flurbiprofen axetil (2mg·hr-1) was administered to inhibit systemic inflammatory response and decrease cellular oxygen demand. As body temperature decreased from 38.2°C to 37.4°C, systolic arterial pressure, cardiac index and oxygen delivery index declined from 130mmHg, 7.8l· min-1·m-2, and 1, 226ml·min-1·m-2 to 80mmHg, 5.7l·min-1·m-2, and 744ml·min-1·m-2, respectively. Body temperature, systolic arterial pressure, cardiac index and oxygen delivery index reached adequate levels of 37.4°C, 100mmHg, 6.1l·min-1·m-2, and 7, 180ml·min-1·m-2, respectively after combined administration of flurbiprofen axetil at a reduced dose of 1.5mg·hr-1, and dobutamine at a dose of 2μg·kg-1·min-1. Mixed venous oxygen saturation decreased to 85.4% and the oxygen extraction ratio increased to 18%. Lactate was reduced to 2.3mg·dl-1.These findings demonstrated improvement of tissue oxygen metabolism. It may be useful to keep a supranormal level of oxygen delivery and to reduce cellular oxygen demand adequately by nonsteroidal anti-inflammatory drugs for the treatment of severe sepsis with oxygen debt.
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