Hepato-splanchnic metabolic effects of the stable prostacyclin analogue iloprost in patients with septic shock.
OBJECTIVE
To evaluate the effects of the stable prostacyclin analogue iloprost on hepato-splanchnic blood flow, oxygen exchange and metabolism in patients with septic shock.


METHODS
Prospective clinical study.


METHODS
Intensive care unit in a university clinic.


METHODS
Eleven patients with septic shock requiring norepinephrine to maintain mean arterial pressure above 70 mmHg.


METHODS
Iloprost was incrementally infused to increase cardiac index by 15%.


RESULTS
Splanchnic blood flow (Qspl) was measured using the steady-state indocyanine-green infusion technique and endogenous glucose production rate (EGP) using a stable isotope approach. Systemic and splanchnic oxygen consumption (VO2), the hepato-splanchnic uptake rates of the glucose precursors lactate, pyruvate, alanine and glutamine, the hepatic venous redox state and gastric mucosal-arterial PCO2 gradients were determined. After a baseline measurement, iloprost infusion was started. After 90 min all measurements were repeated and a third measurement was obtained after another 90 min following iloprost withdrawal. Qspl (baseline I: 0.82/0.75-1.08 l x min x m2; iloprost: 0.94/0.88-1.29 l x min x m2; baseline II: 0.87/0.74-1.09 l x min x m2) and splanchnic oxygen delivery (baseline I: 122/103-166 ml x min x m2; iloprost: 134/117-203 ml x min x m2; baseline II: 130/98-158 ml x min x m2) significantly increased. While systemic VO2 significantly increased (baseline I: 139/131-142 ml x min x m2; iloprost: 147/136-164 ml x min x m2; baseline II: 143/133-154 ml x min x m2) splanchnic VO2 increased in 9 of 11 patients which, however, did not reach statistical significance. EGP significantly decreased (baseline I: 23/16-26 micromol x kg x min; iloprost: 16/14-21 micromol x kg x min; baseline II: 18/12-20 micromol x kg x min), whereas all other parameters of energy metabolism remained unchanged.


CONCLUSIONS
In patients with septic shock an iloprost-induced increase in cardiac index increased splanchnic blood flow and shifted oxygen utilization from the energy requiring de novo glucose production rate to other oxygen-demanding metabolic pathways.
Kiefer
P
P
Department of Anesthesiology, University Clinic Ulm, Germany. peter.kiefer@medizin.uni-ulm.de
Tugtekin
I
I
Wiedeck
H
H
Bracht
H
H
Vogt
J
J
Wachter
U
U
Weiss
M
M
Altin
C
C
Georgieff
M
M
Radermacher
P
P
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016285:Iloprost / Q000494:pharmacology* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008102:Liver Circulation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy*; D013152:Splanchnic Circulation / Q000187:drug effects*; D018709:Statistics, Nonparametric; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use
D001786:Blood Glucose; D014665:Vasodilator Agents; D016285:Iloprost; D010100:Oxygen