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Article: Effects of norepinephrine during intra-abdominal hypertension on renal blood flow in bacteremic dogs

TitleEffects of norepinephrine during intra-abdominal hypertension on renal blood flow in bacteremic dogs
Authors
Issue Date2008
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.org
Citation
Critical Care Medicine, 2008, v. 36 n. 3, p. 834-841 How to Cite?
AbstractObjective: Intraabdominal hypertension reduces organ blood flow. Restoring abdominal perfusion pressure (APP) may restore renal blood flow, especially when sepsis is present. The effects of intra-abdominal pressure (IAP), followed by restoration of APP with norepinephrine, on renal blood flow were determined. Design: Longitudinal study with bacteremia after nonbacteremic (control) conditions. Setting: University animal laboratory. Subjects: Ten anesthetized mongrel dogs. Interventions: IAP was raised to 10, 20, and 30 mm Hg, using intra-abdominal bags filled with saline. After each intervention, decompression was achieved by emptying the bag. Bacteremia was induced by injection of Escherichia coli. Cardiac output and renal blood flow were measured using surgically placed flow probes. Norepinephrine infusion was used to restore the mean arterial pressure to baseline at each IAP. A hypervolemic circulation was maintained throughout by infusing saline. Measurements and Main results: Induction of bacteremia resulted in significant decreases in blood pressure, cardiac output, and renal blood flow (p < .01). Serial increases in IAP decreased cardiac output and renal blood flow both in control and bacteremic dogs (p < .001). These decreases were substantially corrected by abdominal decompression. In nonbacteremic control conditions, restoring APP back to baseline with norepinephrine did not fully restore cardiac output and renal blood flow (p < .001). However, in bacteremic conditions, norepinephrine was able to substantially restore cardiac output and renal blood flow to bacteremic baseline at all levels of IAP. In bacteremic conditions, the renal perfusion fraction returned to bacteremic baseline levels after correction of APP with norepinephrine and after decompression. Conclusions: Restoration of APP using norepinephrine improves renal blood flow in bacteremic animals with IAPs up to 30 mm Hg, and maintaining a therapeutic APP may preserve renal blood flow in patients with intra-abdominal hypertension who are at risk of IAP-induced renal injury but who have yet to meet accepted criteria for surgical decompression. Copyright © 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/145447
ISSN
2015 Impact Factor: 7.422
2015 SCImago Journal Rankings: 3.748
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPeng, ZYen_HK
dc.contributor.authorCritchley, LAen_HK
dc.contributor.authorJoynt, GMen_HK
dc.contributor.authorGruber, PCen_HK
dc.contributor.authorJenkins, CRen_HK
dc.contributor.authorHo, AMHen_HK
dc.date.accessioned2012-02-23T12:10:21Z-
dc.date.available2012-02-23T12:10:21Z-
dc.date.issued2008en_HK
dc.identifier.citationCritical Care Medicine, 2008, v. 36 n. 3, p. 834-841en_HK
dc.identifier.issn0090-3493en_HK
dc.identifier.urihttp://hdl.handle.net/10722/145447-
dc.description.abstractObjective: Intraabdominal hypertension reduces organ blood flow. Restoring abdominal perfusion pressure (APP) may restore renal blood flow, especially when sepsis is present. The effects of intra-abdominal pressure (IAP), followed by restoration of APP with norepinephrine, on renal blood flow were determined. Design: Longitudinal study with bacteremia after nonbacteremic (control) conditions. Setting: University animal laboratory. Subjects: Ten anesthetized mongrel dogs. Interventions: IAP was raised to 10, 20, and 30 mm Hg, using intra-abdominal bags filled with saline. After each intervention, decompression was achieved by emptying the bag. Bacteremia was induced by injection of Escherichia coli. Cardiac output and renal blood flow were measured using surgically placed flow probes. Norepinephrine infusion was used to restore the mean arterial pressure to baseline at each IAP. A hypervolemic circulation was maintained throughout by infusing saline. Measurements and Main results: Induction of bacteremia resulted in significant decreases in blood pressure, cardiac output, and renal blood flow (p < .01). Serial increases in IAP decreased cardiac output and renal blood flow both in control and bacteremic dogs (p < .001). These decreases were substantially corrected by abdominal decompression. In nonbacteremic control conditions, restoring APP back to baseline with norepinephrine did not fully restore cardiac output and renal blood flow (p < .001). However, in bacteremic conditions, norepinephrine was able to substantially restore cardiac output and renal blood flow to bacteremic baseline at all levels of IAP. In bacteremic conditions, the renal perfusion fraction returned to bacteremic baseline levels after correction of APP with norepinephrine and after decompression. Conclusions: Restoration of APP using norepinephrine improves renal blood flow in bacteremic animals with IAPs up to 30 mm Hg, and maintaining a therapeutic APP may preserve renal blood flow in patients with intra-abdominal hypertension who are at risk of IAP-induced renal injury but who have yet to meet accepted criteria for surgical decompression. Copyright © 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.en_HK
dc.languageengen_US
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.orgen_HK
dc.relation.ispartofCritical Care Medicineen_HK
dc.subject.meshAbdomen - physiopathologyen_HK
dc.subject.meshAnimalsen_HK
dc.subject.meshBacteremia - physiopathologyen_HK
dc.subject.meshDogsen_HK
dc.subject.meshKidney - blood supplyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshNorepinephrine - pharmacologyen_HK
dc.subject.meshPressureen_HK
dc.subject.meshRenal Circulation - drug effectsen_HK
dc.titleEffects of norepinephrine during intra-abdominal hypertension on renal blood flow in bacteremic dogsen_HK
dc.typeArticleen_HK
dc.identifier.emailJenkins, CR:cjenkins@hkucc.hku.hken_HK
dc.identifier.authorityJenkins, CR=rp01583en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/CCM.0B013E31816439FBen_HK
dc.identifier.pmid18209675en_HK
dc.identifier.scopuseid_2-s2.0-44449163557en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-44449163557&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume36en_HK
dc.identifier.issue3en_HK
dc.identifier.spage834en_HK
dc.identifier.epage841en_HK
dc.identifier.eissn1530-0293-
dc.identifier.isiWOS:000253450500024-
dc.publisher.placeUnited Statesen_HK

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