Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows

Journal Article · Tue May 01 00:00:00 EDT 1990 · American Review of Respiratory Disease (New York); (USA)

DOI:https://doi.org/10.1164/ajrccm/141.5_Pt_1.1198· OSTI ID:6725102

Bersten, A D; Gnidec, A A; Rutledge, F S; Sibbald, W J ^[1]

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1. Univ. of Western Ontario, London (Canada)

Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) and systemic O2 delivery when compared with the nonseptic study, whereas whole-body O2 extraction was depressed. Although PEEP depressed systemic Q during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2.

• OSTI ID: 6725102
• Journal Information: American Review of Respiratory Disease (New York); (USA), Vol. 141; ISSN 0003-0805
• Country of Publication: United States
• Language: English

Related Subjects

59 BASIC BIOLOGICAL SCIENCES
BACTERIAL DISEASES
PATHOGENESIS
ORGANS
BLOOD FLOW
DEUTERIUM
MICROSPHERES
RESPIRATION
SHEEP
TRACER TECHNIQUES
ANIMALS
BODY
DISEASES
DOMESTIC ANIMALS
HYDROGEN ISOTOPES
INFECTIOUS DISEASES
ISOTOPE APPLICATIONS
ISOTOPES
LIGHT NUCLEI
MAMMALS
NUCLEI
ODD-ODD NUCLEI
RUMINANTS
STABLE ISOTOPES
VERTEBRATES
550901* - Pathology- Tracer Techniques