Abstract
IntroductionWe conducted the present study to investigate whether early large-volume crystalloid infusion can restore gut mucosal blood flow and mesenteric oxygen metabolism in severe sepsis.MethodsAnesthetized and mechanically ventilated male mongrel dogs were challenged with intravenous injection of live Escherichia coli (6 × 109 colony-forming units/ml per kg over 15 min). After 90 min they were randomly assigned to one of two groups – control (no fluids; n = 13) or lactated Ringer's solution (32 ml/kg per hour; n = 14) – and followed for 60 min. Cardiac index, mesenteric blood flow, mean arterial pressure, systemic and mesenteric oxygen-derived variables, blood lactate and gastric carbon dioxide tension (PCO2; by gas tonometry) were assessed throughout the study.ResultsE. coli infusion significantly decreased arterial pressure, cardiac index, mesenteric blood flow, and systemic and mesenteric oxygen delivery, and increased arterial and portal lactate, intramucosal PCO2, PCO2 gap (the difference between gastric mucosal and arterial PCO2), and systemic and mesenteric oxygen extraction ratio in both groups. The Ringer's solution group had significantly higher cardiac index and systemic oxygen delivery, and lower oxygen extraction ratio and PCO2 gap at 165 min as compared with control animals. However, infusion of lactated Ringer's solution was unable to restore the PCO2 gap. There were no significant differences between groups in mesenteric oxygen delivery, oxygen extraction ratio, or portal lactate at the end of study.ConclusionSignificant disturbances occur in the systemic and mesenteric beds during bacteremic severe sepsis. Although large-volume infusion of lactated Ringer's solution restored systemic hemodynamic parameters, it was unable to correct gut mucosal PCO2 gap.
Highlights
We conducted the present study to investigate whether early large-volume crystalloid infusion can restore gut mucosal blood flow and mesenteric oxygen metabolism in severe sepsis
Sepsis leads to endothelial damage, marked alterations in blood flow distribution and altered tissue oxygen metabolism, which are associated with high mortality rates among critically ill patients [1,2,3]
Volume replacement is among the cornerstones of therapy for septic shock [4], studies conducted to elucidate the actual impact of fluid infusion on both experimental and clinical sepsis with respect to systemic endpoints of resuscitation and outcome are inconsistent [5,6,7,8]
Summary
We conducted the present study to investigate whether early large-volume crystalloid infusion can restore gut mucosal blood flow and mesenteric oxygen metabolism in severe sepsis. Volume replacement is among the cornerstones of therapy for septic shock [4], studies conducted to elucidate the actual impact of fluid infusion on both experimental and clinical sepsis with respect to systemic endpoints of resuscitation and outcome are inconsistent [5,6,7,8]. This is largely because of the wide variety of experimental designs and fluid regimens employed. Gut hypoxia or ischemia is one factor that possibly contributes to dysfunction of the gastrointestinal tract barrier, which may in turn contribute to the development of systemic inflammatory response and multiple organ dysfunction syndromes [12,13,14,15]
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