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Open Access 01-12-2015 | Research

Gut and sublingual microvascular effect of esmolol during septic shock in a porcine model

Authors: Matthias Jacquet-Lagrèze, Bernard Allaouchiche, Damien Restagno, Christian Paquet, Jean-Yves Ayoub, Jêrome Etienne, François Vandenesch, Olivier Dauwalder, Jeanne-Marie Bonnet, Stéphane Junot

Published in: Critical Care | Issue 1/2015

Abstract

Introduction

Esmolol may efficiently reduce heart rate (HR) and decrease mortality during septic shock. An improvement of microcirculation dissociated from its macrocirculatory effect may a role. The present study investigated the effect of esmolol on gut and sublingual microcirculation in a resuscitated piglet model of septic shock.

Methods

Fourteen piglets, anesthetized and mechanically ventilated, received a suspension of live Pseudomonas aeruginosa. They were randomly assigned to two groups: the esmolol (E) group received an infusion of esmolol, started at 7.5 μg⋅kg⁻¹⋅min⁻¹, and progressively increased to achieve a HR below 90 beats⋅min⁻¹. The control (C) group received an infusion of Ringer’s lactate solution. HR, mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), systemic vascular resistance (SVR), arterio-venous blood gas and lactate were recorded. Oxygen consumption (VO₂), delivery (DO₂) and peripheral extraction (O₂ER) were computed. Following an ileostomy, a laser Doppler probe was applied on ileal mucosa to monitor gut microcirculatory laser Doppler flow (GMLDF). Videomicroscopy was also used on ileal mucosa and sublingual areas to evaluate mean flow index (MFI), heterogeneity, ratio of perfused villi and proportion of perfused vessels. Resuscitation maneuvers were performed following a defined algorithm.

Results

Bacterial infusion induced a significant alteration of the gut microcirculation with an increase in HR. Esmolol produced a significant time/group effect with a decrease in HR (P <0.004) and an increase in SVR (P <0.004). Time/group effect was not significant for CI and MAP, but there was a clear trend toward a decrease in CI and MAP in the E group. Time/group effect was not significant for SI, O₂ER, DO₂, VO₂, GMLDF and lactate. A significant time/group effect of ileal microcirculation was found with a lower ileal villi perfusion (P <0.025) in the C group, and a trend toward a better MFI in the E group. No difference between both groups was found regarding microcirculatory parameters in the sublingual area.

Conclusions

Esmolol provided a maintenance of microcirculation during sepsis despite its negative effects on macrocirculation. Some parameters even showed a trend toward an improvement of the microcirculation in the gut area in the esmolol group.

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Title: Gut and sublingual microvascular effect of esmolol during septic shock in a porcine model
Authors: Matthias Jacquet-Lagrèze
Bernard Allaouchiche
Damien Restagno
Christian Paquet
Jean-Yves Ayoub
Jêrome Etienne
François Vandenesch
Olivier Dauwalder
Jeanne-Marie Bonnet
Stéphane Junot
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-015-0960-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gut and sublingual microvascular effect of esmolol during septic shock in a porcine model

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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