title: Oxygen consumption and central hemodynamics in septic shock treated with antibiotics, fluid infusions, and corticosteroids.
abstract: The multidimensional pathophysiology of septic shock is poorly understood and treatment modalities are controversial. The present study evaluates the relative importance of three therapeutic measures: antibiotics (trimethoprim and sulphamethoxazole [TS]); fluid infusions (lactated Ringer's solution [RL] and 3% albumin [Alb]), and pharmacologic doses of corticosteroids (CS) (dexamethasone [DM]), using central hemodynamics (plasma volume [PV], cardiac output, oxygen consumption [VO2]), and survival as end-points. Septic shock was induced by intraperitoneal injection of live Escherichia coli bacteria. At 5 h in untreated septic rats, PV had dropped to 76%, cardiac output to 69%, and VO2 to 71% of preshock levels. Untreated septic animals had a mean survival time of 9.7 +/- 1.7 (SD) h, with none surviving 24 h. Regardless of therapy, cardiac output and VO2 at 10 h were predictors of survival time (p less than .01). Treatment was initiated at 5.5 h after bacterial injection, at a time when TS therapy alone had not improved the 24-h survival rate. Animals treated with DM, RL, and Alb, in this order, exhibited progressively improved central hemodynamics, and 24-h survival rate increased to 60% compared with 0 in untreated animals (p less than .001). The combination of DM and RL produced no further improvement. However, DM combined with 3% Alb restored VO2, cardiac output, and PV to 81%, 100%, and 125%, respectively, increasing the 24-h survival rate to 97% (29/30), significantly greater than that achieved by any other treatment modality (p less than .05).
authors: Department of Surgery, University of Texas Southwestern Medical Center at Dallas 75235.
authors: J
authors: J
authors: Ottosson
authors: T
authors: T
authors: Persson
authors: I
authors: I
authors: Dawidson
mesh_terms: D000818:Animals; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use*; D004338:Drug Combinations / Q000627:therapeutic use; D005440:Fluid Therapy; D006439:Hemodynamics; D008297:Male; D010101:Oxygen Consumption; D051381:Rats; D011919:Rats, Inbred Strains; D012772:Shock, Septic / Q000503:physiopathology / Q000628:therapy*; D013420:Sulfamethoxazole / Q000627:therapeutic use*; D014295:Trimethoprim / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D004338:Drug Combinations; D003907:Dexamethasone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole