Is persistent hypotension after transient cardiogenic shock associated with an inflammatory response?
We evaluated the recovery of cardiovascular function after transient cardiogenic shock. Cardiac tamponade was performed for 1 h and post-shock data were collected in 5 domestic large white female pigs (43 +/- 5 kg) for 6 h. The control group (N = 5) was observed for 6 h after 1 h of resting. During 1 h of cardiac tamponade, experimental animals evolved a low perfusion status with a higher lactate level (8.0 +/- 2.2 vs 1.9 +/- 0.9 mEq/L), lower standard base excess (-7.3 +/- 3.3 vs 2.0 +/- 0.9 mEq/L), lower urinary output (0.9 +/- 0.9 vs 3.0 +/- 1.4 mL x kg(-1) x h(-1)), lower mixed venous saturation, higher ileum partial pressure of CO2-end tidal CO2 (EtCO2) gap and a lower cardiac index than the control group. Throughout the 6-h recovery phase after cardiac tamponade, tamponade animals developed significant tachycardia with preserved cardiac index, resulting in a lower left ventricular stroke work, suggesting possible myocardial dysfunction. Vascular dysfunction was present with persistent systemic hypotension as well as persistent pulmonary hypertension. In contrast, oliguria, hyperlactatemia and metabolic acidosis were corrected by the 6th hour. The inflammatory characteristics were an elevated core temperature and increased plasma levels of interleukin-6 in the tamponade group compared to the control group. We conclude that cardiovascular recovery after a transient and severe low flow systemic state was incomplete. Vascular dysfunction persisted up to 6 h after release of tamponade. These inflammatory characteristics may also indicate that inflammatory activation is a possible pathway involved in the pathogenesis of cardiogenic shock.
Park
M
M
Laboratório de Pesquisa em Medicina Intensiva e Anestesiologia, Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil. mpark@uol.com.br <mpark@uol.com.br>
Maciel
A T
AT
Noritomi
D T
DT
Brunialti
M K
MK
Salomão
R
R
Schettino
G P P
GP
Azevedo
L C P
LC
D000818:Animals; D002305:Cardiac Tamponade / Q000097:blood / Q000503:physiopathology*; D005260:Female; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology*; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000097:blood / Q000503:physiopathology*; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors