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Prognostic importance of plasma biomarkers in experimental sepsis
Abstracts / Journal of Critical Care 40 (2017?) 324–325
Discussion: Hemodynamic alterations could be detected after the onset of antimycotic treatment with Amphotericin in septic patients. With regard to comorbidities of patients with sepsis, it seems reasonable that changes in cardiac electric activity in humans during their intensive care unit stay might be observed even earlier.
325
294 (193-370) mm Hg vs 226 (164-279) mm Hg in the EVLWI group, respectively (P = .18). The DT in both groups did not influence vasopressor support and survival rate. Discussion: The target DT of ARDS based on GEDVI attenuates pulmonary edema more efficiently as compared with the fluid management guided by EVLWI alone.
http://dx.doi.org/10.1016/j.jcrc.2017.07.005 http://dx.doi.org/10.1016/j.jcrc.2017.07.006
Dehydration therapy in acute respiratory distress syndrome guided by global end-diastolic volume and extravascular lung water Aleksey A. Ushakov*, Evgeniya V. Fot, Yana Y. Ilina, Vsevolod V. Kuzkov, Mikhail Y. Kirov Northern State Medical University, Arkhangelsk, Russian Federation ⁎Corresponding author. Tel.: +7 89214753728. E-mail address: [email protected] (A.A. Ushakov) Introduction: Fluid overload plays an important role in the development of pulmonary edema in critically ill patients. Thus, the goaldirected fluid management serves as a key component in the therapy of acute respiratory distress syndrome (ARDS). The aim of our study was to compare the dehydration therapy (DT) in ARDS guided by global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI). Materials and methods (case report): Twenty-two mechanically ventilated adult patients with ARDS of pulmonary and nonpulmonary origin were enrolled into an ongoing prospective study. All patients received invasive hemodynamic monitoring using transpulmonary thermodilution (PiCCO2, Pulsion, Germany). Patients were randomized to 2 groups of DT guided by either GEDVI (n = 12) or EVLWI (n = 10). In the GEDVI group, the target fluid balance was in range from 0 to 3000 mL if GEDVI was b650 mL/m2 and in range from 0 to −3000 mL in case of GEDVI N650 mL/m2. In the EVLWI group, the target fluid balance was in range from 0 to 3000 mL if EVLWI was b10 mL/kg and in range from 0 to −3000 mL in case of EVLWI N10 mL/kg, respectively. The DT was provided by continuous intravenous infusion of furosemide at a dose of 0.07 mg/(kg h) during 12 hours. The measurements included hemodynamics and blood gases. The statistical analysis was performed using Mann-Whitney U test and χ2 test. Data are presented as median (25th75th percentiles). A P value b .05 was regarded as statistically significant. Results: We found no baseline differences in the studied parameters between the groups. The target fluid balance during 48 hours was achieved in both groups. At 48 hours, EVLWI was reduced by 1 (−2.7 to +1.5) mL/kg in the GEDVI group and increased by 3 (− 1 to + 7) mL/kg in the EVLWI-guided group (P = .01). These changes were accompanied by a trend to reduction in total fluid balance for 48 hours in the GEDVI group: −2450 (− 2912 to −910) mL vs −1475 (−1932 to + 540) mL in the EVLWI group (P = .16). The Pao2/Fio2 ratio after 12 hours of DT also tended to improve in the GEDVI group:
Prognostic importance of plasma biomarkers in experimental sepsis Rasha Srour*, Renáta Halcsik, László Juhász, Marietta Zita Poles, Dániel Érces, Mihály Boros, József Kaszaki Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary ⁎Corresponding author. Tel.: +36 703761783. E-mail address: [email protected] (R. Srour) Introduction: In septic conditions, the transiently increased oxygen delivery (DO2) can compensate the higher oxygen consumption (VO2) caused by the inflammation; however, generalized cellular hypoxia will develop on the long run. This biphasic process is accompanied by hemodynamic changes and the release of several mediators, and it is still unclear which biomarker may be of prognostic importance. Our aim was to determine the exact relationship between the changes of VO2-DO2 ratio and plasma biomarkers in a clinically relevant model of abdominal sepsis. Materials and methods (case report): Anesthetized minipigs were subjected to fecal peritonitis (n = 16, 0.5 g/kg autofeces i.p.) or sham operation (i.p. saline, n = 6). Invasive hemodynamic monitoring was started with regular blood gas analyses between 16 and 24 hours of the insult to calculate VO2-DO2 values, and in parallel, the plasma levels of big-endothelin, tumor necrosis factor–alpha, interleukin-10, and high mobility group box protein-1 (HMGB1) were determined by enzyme-linked immunosorbent assay technique. Results: At 24 hours of sepsis, the VO2-DO2 ratio significantly decreased below the control in 9 animals (severe subgroup), whereas it was significantly higher in 7 (moderate subgroup). The HMGB1 plasma concentrations were significantly elevated at 6-16 hours of peritonitis in the severe subgroup (2.9-19.7 ng/mL) but not in the controls and moderately septic subgroup (0.3-1.8 ng/mL). The big-endothelin, but not the tumor necrosis factor-alpha and interleukin-10 levels, showed similar changes. A significant negative correlation (r = −0.782) was found between late O2 extraction ratios and early HMGB1 changes. Discussion: Early elevation of plasma HMGB1 is predictive and correlates with the deterioration of O2 extraction in the later phases of sepsis. This work was supported by OTKA K104656 and NKFIK K116689. http://dx.doi.org/10.1016/j.jcrc.2017.07.007
Discussion: Hemodynamic alterations could be detected after the onset of antimycotic treatment with Amphotericin in septic patients. With regard to comorbidities of patients with sepsis, it seems reasonable that changes in cardiac electric activity in humans during their intensive care unit stay might be observed even earlier.
325
294 (193-370) mm Hg vs 226 (164-279) mm Hg in the EVLWI group, respectively (P = .18). The DT in both groups did not influence vasopressor support and survival rate. Discussion: The target DT of ARDS based on GEDVI attenuates pulmonary edema more efficiently as compared with the fluid management guided by EVLWI alone.
http://dx.doi.org/10.1016/j.jcrc.2017.07.005 http://dx.doi.org/10.1016/j.jcrc.2017.07.006
Dehydration therapy in acute respiratory distress syndrome guided by global end-diastolic volume and extravascular lung water Aleksey A. Ushakov*, Evgeniya V. Fot, Yana Y. Ilina, Vsevolod V. Kuzkov, Mikhail Y. Kirov Northern State Medical University, Arkhangelsk, Russian Federation ⁎Corresponding author. Tel.: +7 89214753728. E-mail address: [email protected] (A.A. Ushakov) Introduction: Fluid overload plays an important role in the development of pulmonary edema in critically ill patients. Thus, the goaldirected fluid management serves as a key component in the therapy of acute respiratory distress syndrome (ARDS). The aim of our study was to compare the dehydration therapy (DT) in ARDS guided by global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI). Materials and methods (case report): Twenty-two mechanically ventilated adult patients with ARDS of pulmonary and nonpulmonary origin were enrolled into an ongoing prospective study. All patients received invasive hemodynamic monitoring using transpulmonary thermodilution (PiCCO2, Pulsion, Germany). Patients were randomized to 2 groups of DT guided by either GEDVI (n = 12) or EVLWI (n = 10). In the GEDVI group, the target fluid balance was in range from 0 to 3000 mL if GEDVI was b650 mL/m2 and in range from 0 to −3000 mL in case of GEDVI N650 mL/m2. In the EVLWI group, the target fluid balance was in range from 0 to 3000 mL if EVLWI was b10 mL/kg and in range from 0 to −3000 mL in case of EVLWI N10 mL/kg, respectively. The DT was provided by continuous intravenous infusion of furosemide at a dose of 0.07 mg/(kg h) during 12 hours. The measurements included hemodynamics and blood gases. The statistical analysis was performed using Mann-Whitney U test and χ2 test. Data are presented as median (25th75th percentiles). A P value b .05 was regarded as statistically significant. Results: We found no baseline differences in the studied parameters between the groups. The target fluid balance during 48 hours was achieved in both groups. At 48 hours, EVLWI was reduced by 1 (−2.7 to +1.5) mL/kg in the GEDVI group and increased by 3 (− 1 to + 7) mL/kg in the EVLWI-guided group (P = .01). These changes were accompanied by a trend to reduction in total fluid balance for 48 hours in the GEDVI group: −2450 (− 2912 to −910) mL vs −1475 (−1932 to + 540) mL in the EVLWI group (P = .16). The Pao2/Fio2 ratio after 12 hours of DT also tended to improve in the GEDVI group:
Prognostic importance of plasma biomarkers in experimental sepsis Rasha Srour*, Renáta Halcsik, László Juhász, Marietta Zita Poles, Dániel Érces, Mihály Boros, József Kaszaki Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary ⁎Corresponding author. Tel.: +36 703761783. E-mail address: [email protected] (R. Srour) Introduction: In septic conditions, the transiently increased oxygen delivery (DO2) can compensate the higher oxygen consumption (VO2) caused by the inflammation; however, generalized cellular hypoxia will develop on the long run. This biphasic process is accompanied by hemodynamic changes and the release of several mediators, and it is still unclear which biomarker may be of prognostic importance. Our aim was to determine the exact relationship between the changes of VO2-DO2 ratio and plasma biomarkers in a clinically relevant model of abdominal sepsis. Materials and methods (case report): Anesthetized minipigs were subjected to fecal peritonitis (n = 16, 0.5 g/kg autofeces i.p.) or sham operation (i.p. saline, n = 6). Invasive hemodynamic monitoring was started with regular blood gas analyses between 16 and 24 hours of the insult to calculate VO2-DO2 values, and in parallel, the plasma levels of big-endothelin, tumor necrosis factor–alpha, interleukin-10, and high mobility group box protein-1 (HMGB1) were determined by enzyme-linked immunosorbent assay technique. Results: At 24 hours of sepsis, the VO2-DO2 ratio significantly decreased below the control in 9 animals (severe subgroup), whereas it was significantly higher in 7 (moderate subgroup). The HMGB1 plasma concentrations were significantly elevated at 6-16 hours of peritonitis in the severe subgroup (2.9-19.7 ng/mL) but not in the controls and moderately septic subgroup (0.3-1.8 ng/mL). The big-endothelin, but not the tumor necrosis factor-alpha and interleukin-10 levels, showed similar changes. A significant negative correlation (r = −0.782) was found between late O2 extraction ratios and early HMGB1 changes. Discussion: Early elevation of plasma HMGB1 is predictive and correlates with the deterioration of O2 extraction in the later phases of sepsis. This work was supported by OTKA K104656 and NKFIK K116689. http://dx.doi.org/10.1016/j.jcrc.2017.07.007