+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock



Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock



Critical Care 20(1): 234



Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock. Eighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experiments. Dexmedetomidine and esmolol were hemodynamically well tolerated. The dexmedetomidine group exhibited lower epinephrine levels, but no difference in muscle lactate. Despite progressive hypotension in all groups, both dexmedetomidine and esmolol were associated with lower arterial and portal vein lactate levels. Exogenous lactate clearance was significantly higher in the dexmedetomidine and esmolol groups. Dexmedetomidine and esmolol were associated with lower arterial and portal lactate levels, and less impairment of exogenous lactate clearance in a model of septic shock. The use of dexmedetomidine and esmolol appears to be associated with beneficial effects on gut lactate generation and lactate clearance and exhibits no negative impact on systemic hemodynamics.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 057726721

Download citation: RISBibTeXText

PMID: 27480413

DOI: 10.1186/s13054-016-1419-x


Related references

Impairment of exogenous lactate clearance in experimental hyperdynamic septic shock is not related to total liver hypoperfusion. Critical Care 19: 188, 2015

Effects of esmolol on systemic hemodynamics and heart rate variability measured using the Analgesia/Nociception Index in resuscitated piglets with Pseudomonas aeruginosa septic shock. Journal of Veterinary Emergency and Critical Care 28(5): 447-456, 2018

Effect of Dexmedetomidine on Lactate Clearance in Patients With Septic Shock: A Subanalysis of a Multicenter Randomized Controlled Trial. Shock 50(2): 162-166, 2018

Low exogenous lactate clearance as an early predictor of mortality in normolactatemic critically ill septic patients. Critical Care Medicine 31(3): 705-710, 2003

Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock. Intensive Care Medicine 37(8): 1344-1351, 2011

Adipose Tissue Lactate Clearance but Not Blood Lactate Clearance Is Associated with Clinical Outcome in Sepsis or Septic Shock during the Post-Resuscitation Period. Metabolites 8(2):, 2018

Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Critical Care Medicine 32(8): 1637-1642, 2004

Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock. Critical Care 20(1): 407, 2016

A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock. Journal of Trauma and Acute Care Surgery 73(4): 855-860, 2012

Effect of esmolol on hemodynamics and clinical outcomes in patients with septic shock. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 29(5): 390-395, 2017

The effect of early goal lactate clearance rate on the outcome of septic shock patients with severe pneumonia. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 24(1): 42-45, 2012

Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. Journal of Inflammation 7: 6, 2010

Pulmonary ultrastructure and hemodynamics in early experimental septic shock. European Surgical Research 9(Suppl. 1): 16, 1977

Relationship of systemic, hepatosplanchnic, and microcirculatory perfusion parameters with 6-hour lactate clearance in hyperdynamic septic shock patients: an acute, clinical-physiological, pilot study. Annals of Intensive Care 2(1): 44, 2012

The relationship between arterial blood lactate clearance, prognosis and myocardial damage in patients with septic shock after early goal-directed therapy. Zhonghua Nei Ke Za Zhi 57(5): 345-350, 2018