title: ISCHEMIC CONDITIONING PROTECTS THE MICROCIRCULATION, PRESERVES ORGAN FUNCTION, AND PROLONGS SURVIVAL IN SEPSIS.
abstract: Ischemic conditioning induces a series of cellular modifications that may prevent injury from further hypoxic episodes, but there are few data in sepsis. In this randomized controlled study, we evaluated the effects of ischemic conditioning on the microcirculation, organ function, and survival time in an ovine model of septic shock.Sepsis was induced in 14 anesthetized, mechanically ventilated adult sheep by injecting autologous feces into the abdominal cavity. Animals were then randomized to ischemic pre- and post-conditioning or no conditioning (both n = 7). Remote ischemic conditioning was performed by inflating the balloon of a catheter in the aortic bifurcation for 2 min, followed by a 4-min deflation period. The procedure was performed four times before sepsis induction and 4-hourly afterward. Animals were followed until death or for a maximum of 30 h. Hemodynamic, oxygenation, and microcirculatory variables were monitored. The conditioned group had higher mixed venous oxygen saturation from 8 h after randomization, higher cardiac index, and oxygen delivery from 16 h, and higher mean arterial pressure and lower lactate levels from 20 h. They also had greater renal blood flow, urine output, and creatinine clearance. Microcirculatory variables were better preserved in the conditioned than in the control group from 6 h after randomization: the median proportion of perfused vessels was 91 (89-93)% versus 89 (86-90)% (P = 0.024) and there was less heterogeneity. Oliguria, hypotension, and death occurred later in the conditioned than in the control group. In this sepsis model, remote ischemic pre- and post-conditioning therefore decreased organ dysfunction, preserved the microcirculation, and prolonged survival.
authors: Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors: Diego
authors: D
authors: Orbegozo Cortés
authors: Fuhong
authors: F
authors: Su
authors: Carlos
authors: C
authors: Santacruz
authors: Koji
authors: K
authors: Hosokawa
authors: Katia
authors: K
authors: Donadello
authors: Jacques
authors: J
authors: Creteur
authors: Daniel
authors: D
authors: De Backer
authors: Jean-Louis
authors: JL
authors: Vincent
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D019194:Ischemic Preconditioning / Q000379:methods*; D008833:Microcirculation; D018805:Sepsis / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D012756:Sheep; D013997:Time Factors