title: Oxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock.
abstract: OBJECTIVE
  To investigate the influence of the neuromuscular blocking agent vecuronium on oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction ratio, and gastric intramucosal pH in heavily sedated patients with severe sepsis or septic shock.
  
  
  METHODS
  Prospective, randomized, placebo-controlled, cross-over trial.
  
  
  METHODS
  University hospital intensive care unit.
  
  
  METHODS
  Eighteen mechanically ventilated patients with severe sepsis or septic shock.
  
  
  METHODS
  All patients were heavily sedated. After baseline measurement, a computer-controlled, closed-loop infusion of either vecuronium or saline was initiated and further measurements were made at 40 and 60 mins. The procedure was repeated with the alternative agent after return of neuromuscular function.
  
  
  RESULTS
  DO2, VO2, intramucosal pH were monitored using pulmonary artery catheters, a gas exchange monitor, and gastric tonometers. Changes from baseline were compared (paired t-test, p = .05). The vecuronium closed-loop infusion achieved T1 between 5% and 15% at 40 mins. There was a significant difference in the changes from baseline for static respiratory compliance in the vecuronium closed-loop infusion group compared with the saline closed-loop infusion group. There was no significant difference in the change from baseline for systemic or pulmonary vascular resistance, DO2, VO2, oxygen extraction ratio, or intramucosal pH.
  
  
  CONCLUSIONS
  In these patients, vecuronium infusion achieved the targeted level of paralysis and improved respiratory compliance but did not alter intramucosal pH, VO2, DO2, or oxygen extraction ratios. With deep sedation, neuromuscular blockade in severe sepsis/septic shock does not significantly influence oxygen flux and should be abandoned as a routine method of improving tissue oxygenation in these patients.
authors.affiliation: Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin.
authors.forename: R C
authors.initials: RC
authors.lastname: Freebairn
authors.forename: J
authors.initials: J
authors.lastname: Derrick
authors.forename: C D
authors.initials: CD
authors.lastname: Gomersall
authors.forename: R J
authors.initials: RJ
authors.lastname: Young
authors.forename: G M
authors.initials: GM
authors.lastname: Joynt
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous; D005260:Female; D005753:Gastric Mucosa / Q000737:chemistry / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007260:Infusion Pumps; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000494:pharmacology*; D010100:Oxygen / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D018805:Sepsis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D012772:Shock, Septic / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D013270:Stomach / Q000737:chemistry / Q000187:drug effects*; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D010100:Oxygen