Inhibition of Prostaglandin Synthesis Restores Normal Hemodynamics in Canine Hyperdynamic Sepsis

摘要

This study investigates the role of prostaglandins (PG) in hyperdynamic sepsis. Thirteen chronically instrumented dogs were rendered septic by implanting in the peritoneal cavity a fibrin clot containing viable Escherichia coli. One day later, cardiac output (CO) increased from 2.80 + or - 0.22 to 3.72 + or - 0.32 1/min (p=0.011); heart rate (HR) increased from 122 + or - 8 to 147 + or - 6 beats/min (p = 0.005); mean pulmonary artery pressure (PAP) increased from 15 + or - 1 to 19 + or - 1 mmHg (p=0.003); mean systemic arterial pressure (MAP) decreased from 120 + or - 5 to 107 + or - 7 mmHg; and systemic vascular resistance (SVR) decreased from 44.1 + or - 2.6 to 29.3 + or - 1.9 mmHg/1/min (p<0.001). Sixty minutes after intravenous injection of indomethacin (2 mg/kg) or ibuprofen (25 mg/kg), CO decreased to 2.60 + or - 0.21 1/min (p<0.001); HR decreased to 118 + or - 5 beats/min (p<0.001); PAP decreased to 17 + or - 1 mmHg (p = 0.021); and SVR increased to 43.7 mmHg/1/min (p<0.001). In seven control dogs, laparotomy alone did not significantly affect any of these parameters. Infusion of indomethacin caused a slight increase in MAP (106 + or - 4 to 116 + or - 4 mmHg, p = 0.035) but otherwise did not alter hemodynamics. It is concluded that administration of indomethacin or ibuprofen restores normal hemodynamics in a canine model of high-output sepsis, probably by inhibiting PG synthesis.