Enalaprilat improves systemic and mesenteric blood flow during resuscitation from hemorrhagic shock in dogs.
We investigated the systemic and mesenteric cardiovascular effects of administering enalaprilat during resuscitation from hemorrhage. Dogs were hemorrhaged (mean arterial pressure [MAP] 40-45 mmHg for 30 min, then 30-35 mmHg for 30 min) and were then resuscitated with intermittent lactated Ringer's solution (200 mL/kg/h during first 40 min, and 60 mL/kg/h during the following 130 min, MAP 75-80 mmHg). A constant-rate infusion of saline with or without enalaprilat (0.02 mg/kg/h) was initiated after 40 min of resuscitation. Blood flows declined with hemorrhage, increased with resuscitation, and then declined during the initial 40 min of resuscitation. Enalaprilat administration resulted in blood flow increases not seen in the controls (ending values for cardiac index: 2.8 +/- 0.4 L/min/m2 vs. 1.6 +/- 0.3 L/min/m2; celiac arterial flow 314 +/- 66 L/min/m2 vs. 139 +/- 13 mL/min/m2; and portal venous flow 596 +/- 172 L/min/m2 vs. 414 +/- 81 mL/min/m2 for enalaprilat versus controls, respectively). The greater flows with enalaprilat appeared to be due to prevention of the increases in afterload noted in the controls (ending arterial elastance values 3.73 +/- 0.97 mmHg/m2/mL vs. 7.74 +/- 1.80 mmHg/m2/mL for enalaprilat versus controls, respectively). We conclude that administration of a constant-rate infusion of enalaprilat during resuscitation can be used to improve systemic and mesenteric blood flow.
Wall
Piper
P
Department of Surgery Education and Trauma Research, Iowa Methodist Medical Center, Des Moines, Iowa 50309, USA.
Buising
Charisse
C
Henderson
LaRhee
L
Freeman
Brian
B
Vincent
Robert
R
Albright
Jeffrey
J
Paradise
Norman
N
D000818:Animals; D001783:Blood Flow Velocity / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D004285:Dogs; D004562:Electrocardiography; D004656:Enalapril / Q000627:therapeutic use*; D012039:Regional Blood Flow / Q000187:drug effects; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000503:physiopathology*; D013152:Splanchnic Circulation / Q000187:drug effects*
D004656:Enalapril