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Effects of Catecholamine Therapy on Regional Blood Flow and Tissue Oxygenation in Septic Shock

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine 1994

Part of the book series: Yearbook of Intensive Care and Emergency Medicine 1994 ((YEARBOOK,volume 1994))

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Abstract

Septic shock is characterized by major disturbances of vaso-regulation and oxygen transport DO2, resulting in maldistribution of blood flow in relation to tissue O2 demand, and consequently tissue hypoxia. The principal hemodynamic abnormality is widespread arteriolar vasodilatation, resulting in systemic hypotension, which is frequently compounded by hypovolemia caused by increased capillary permeability. Restoration of circulating volume leads generally to a clinical picture characterized by a normal or high cardiac index (CI) with a reduced systemic vascular resistance (SVR). There is now good evidence that the generalized vasodilation is caused, at least in part, by excess release from the vascular endothelium of nitric oxide (NO), the synthesis of which is induced by lipopolysaccharide (LPS) and cytokines such as tumour necrosis factor-α (TNF-α) and interleukin-1 (IL-1) [1]. Despite the high overall cardiac output and generalized vasodilation, the presence of flow-dependent oxygen consumption (VO2) at high levels of DO2 and of hyperlactatemia in many cases implies inadequate perfusion and DO2 in regional vascular beds [2, 3]. Regional hypoperfusion may be absolute as in low cardiac output states, or relative to increased regional O2 demand. While the latter situation is more typical of high output septic shock, the presence of high circulating levels of the potent vasoconstrictor, endothelin-1 in patients with sepsis and multiple organ failure (MOF) suggests that it may be implicated in causing regional vasoconstriction [4].

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Authors
  1. I. S. Grant
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  2. K. P. Kelly
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  3. A. F. Mackenzie
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Clinical Director) (Clinical Director)

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© 1994 Springer-Verlag Berlin Heidelberg

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Grant, I.S., Kelly, K.P., Mackenzie, A.F. (1994). Effects of Catecholamine Therapy on Regional Blood Flow and Tissue Oxygenation in Septic Shock. 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_18

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  • DOI: https://doi.org/10.1007/978-3-642-85068-4_18

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-57613-6

  • Online ISBN: 978-3-642-85068-4

  • eBook Packages: Springer Book Archive

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