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

Related Subjects

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