title: Use of insulin to decrease septic shock-induced myocardial depression in a porcine model.
abstract: Insulin is known to attenuate septic shock-induced myocardial depression. Possible mechanisms include an anti-inflammatory or inotropic effect of insulin. The objective of this study was to determine whether the mechanism of action of insulin in attenuating septic shock-induced myocardial depression is through an immunomodulatory effect. Fourteen pigs were assigned to one of two groups. Both groups received a 4-h infusion of lipopolysaccharide endotoxin from Escherichia coli 0111:B4. Group 2 additionally received insulin at 1.5 U/kg/h with infusions of D50 normal saline and KCl to maintain normal serum glucose and potassium levels. Cardiac function was measured with shortening fraction using transthoracic echocardiogram. Plasma TNF-α, IL-1β, and IL-6 levels were obtained every 30 min. Postmortem cytokine analysis and histomorphology were performed on the heart tissue. Although insulin attenuated septic shock-induced myocardial depression, this was not due to an anti-inflammatory effect and, therefore, likely resulted from an inotropic effect of insulin.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA, yosef.levenbrown@nemours.org.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Levenbrown
authors.forename: Scott
authors.initials: S
authors.lastname: Penfil
authors.forename: Elena
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.forename: A Majeed
authors.initials: AM
authors.lastname: Bhat
authors.forename: Anne
authors.initials: A
authors.lastname: Hesek
authors.forename: Karen B
authors.initials: KB
authors.lastname: O'Neil
authors.forename: Kelly
authors.initials: K
authors.lastname: Tobin
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shaffer
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects; D004452:Echocardiography; D004731:Endotoxins / Q000008:administration & dosage; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006334:Heart Function Tests; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D056747:Immunomodulation / Q000187:drug effects; D007328:Insulin / Q000627:therapeutic use; D053583:Interleukin-1beta / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008070:Lipopolysaccharides / Q000008:administration & dosage; D009200:Myocardial Contraction / Q000187:drug effects*; D012772:Shock, Septic / Q000188:drug therapy* / Q000473:pathology; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D001786:Blood Glucose; D004731:Endotoxins; D007004:Hypoglycemic Agents; D007328:Insulin; D053583:Interleukin-1beta; D015850:Interleukin-6; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; C044101:endotoxin, Escherichia coli