Abstract
Severe sepsis and septic shock are characterized by hypoperfusion abnormalities and sepsis-induced hypotension despite adequate fluid resuscitation [1]. Hypoperfusion abnormalities include oliguria, lactic acidosis or impaired splanchnic oxygenation [1, 2] which may result in the development of the multiple organ dysfunction syndrome (MOF) [1–3]. Therefore, resuscitation consisting of volume expansion, red cell transfusion and/or infusion of vasoactive drugs aims at increasing global oxygen delivery (DO2) [4, 5] and thereby restoring regional oxygenation. In this context, at first glance infusing prostacyclin (PGI2) in patients with sepsis or septic shock seems to be paradoxical: administering a vasodilator generally aggravates the hemodynamic profile characterized by low perfusion pressures and high cardiac output associated with increased venous admixture [6]. Despite these possible drawbacks, this chapter will discuss the potential role of PGI2 in the treatment of sepsis.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Bone RC and members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874
Fink MP (1991) Gastrointestinal mucosal injury in experimental models of shock, trauma, and sepsis. Crit Care Med 19: 627–641
Fiddian-Green RG (1992) Tonometry: Theory and applications. Intensive Care World 9: 60–65
Shoemaker WC, Appel PL, Kram HB (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186
Edwards JD, Brown GCS, Nightingale P, Slater RM, Faragher EB (1989) Use of survivors’ cardiorespiratory values as therapeutic goals in septic shock. Crit Care Med 17: 1098–1103
Parillo JE (1993) Pathogenetic mechanisms of septic shock. N Engl J Med 328: 1471–1477
Bunting S, Gryglewski R, Moncada S, Vane JR (1976) Arterial walls generate from prostaglandin endoperoxides a substance (prostaglandin X) which relaxes strips of mesenteric and coeliac arteries and inhibits platelet aggregation. Prostaglandins 12: 897–913
Bihari DJ, Tinker J (1988) The therapeutic value of vasodilator prostaglandins in multiple organ failure associated with sepsis. Intensive Care Med 15: 2–7
Lefer AM, Tabas J, Smith EF (1980) Salutary effects of prostacyclin in endotoxic shock. Pharmacology 21: 206–212
Krausz MM, Ustonomiya T, Feuerstein G, Wolfe JHN, Shepro D, Hechtman HB (1981) Prostacyclin reversal of lethal endotoxemia in dogs. J Clin Invest 67: 1118–1125
Ditter H, Matthias FR, Voss R, Lohmann E (1988) Beneficial effects of prostacyclin in a rabbit endotoxin shock model. Thromb Res 51: 403–415
Muller B, Schmidtke M, Witt W (1987) Action of the stable prostacyclin analogue iloprost on microvascular tone and permeability in the hamster cheek pouch. Prostagland Leukotr Med 29: 187–198
Kaufman RP, Kobzik L, Shepro D, Anner H, Valeri CR, Hechtman HB (1988) Vasodilator prostaglandins ( PG) prevent renal damage after ischemia. Ann Surg 205: 195–198
Seelig RF, Kerr JC, Hobson RW, Machiedo GW (1981) Prostacyclin (epoprostenol) — Its effect on canine splanchnic blood flow during hemorrhagic shock. Arch Surg 116: 428–430
Gaskill HV, Sirinek KR, Levine BA (1984) Prostacyclin selectively enhances blood flow in areas of the GI tract prone to stress ulceration. J Trauma 24: 397–402
Konturek SJ, Robert A (1982) Cytoprotection of canine gastric mucosa by prostacyclin: Possible mediation by increased mucosal blood flow. Digestion 25: 155–163
Rasmussen I, Arvidsson D, Zak A, Haglund U (1992) Splanchnic and total body oxygen consumption in experimental fecal peritonitis in pigs: Effects of dextran and iloprost. Circ Shock 36: 299–306
Tokyay R, Zeigler ST, Traber DL, et al (1993) Postburn vasoconstriction increases bacterial and endotoxin translocation. J Appl Physiol 74: 1521–1527
Gutierrez G, Palizas F, Doglio G, et al (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339: 195–199
Bihari DJ, Smithies M, Gimson A, Tinker J (1987) The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 317: 397–403
Pittet JF, Lacroix JS, Gunning K, Laverrier MC, Morel DR, Suter PM (1990) Prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure. Chest 98: 1467–1472
Wolfe RR (1982) Stable isotope approaches for the study of energy metabolism. Fed Proc 41: 2692–2697
Ronco JJ, Fenwick JC, Wiggs BW, Phang PT, Russel JA, Tweeddale MG (1993) Oxygen consumption is independent of increases in oxygen delivery by dobutamine in septic patients who have normal or increased plasma lactate. Am Rev Respir Dis 147: 25–31
Hassan S, Pickles H (1983) Epoprostenol (prostacyclin, PGI2) increases apparent liver blood flow in man. Prostagland Leukotr Med 10: 449–454
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Radermacher, P., Scheeren, T., Weiss, M. (1994). Treatment of Sepsis: A New Look at Prostacyclin. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1994. Yearbook of Intensive Care and Emergency Medicine 1994, vol 1994. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-85068-4_6
Download citation
DOI: https://doi.org/10.1007/978-3-642-85068-4_6
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-57613-6
Online ISBN: 978-3-642-85068-4
eBook Packages: Springer Book Archive