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The haemodynamic and metabolic effects of epinephrine in experimental hyperdynamic septic shock

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Abstract

Objective

To study the effect of epinephrine (EPI) infusion on vital organ blood flow and metabolic variables during sepsis.

Design and setting

Randomised placebo-controlled animal trial in an animal laboratory.

Animals

Seven merino cross-ewes.

Interventions

Chronic implantation of flow probes (aorta, renal, mesenteric and coronary artery and sagittal sinus). Induction of sepsis by intravenous injection of E. coli. Random allocation of sheep to EPI (0.4 µg kg−1 min−1) or vehicle for 6 h.

Measurements and results

E. coli induced hypotension and hyperlactataemia and increased cardiac output, renal, mesenteric and coronary blood flows. Compared to vehicle, EPI restored mean arterial blood pressure (69 vs. 86 mmHg) and further increased cardiac output (6.4 vs. 7.1 l/min). EPI, however, decreased renal blood flow (330 vs. 247 ml/min) and renal conductance. EPI also reduced mesenteric and coronary conductance without changes in flows. Compared to vehicle, EPI increased urine output (293 vs. 544 ml/6 h) but not creatinine clearance. EPI increased lactate (1.8 vs. 15.7 mmol/l) with accompanying acidosis (serum bicarbonate: 25.2 vs. 15.7 mmol/l), hyperglycaemia (2.6 vs. 13.5 mmol/l) and hypokalaemia (4.3 vs. 3.0 mmol/l).

Conclusions

Hyperdynamic sepsis increased blood flow to heart, gut and kidney. Although EPI infusion further increased cardiac output, blood pressure and myocardial performance, it was also associated with potent metabolic effects, decreased mesenteric, coronary and renal conductance and a significant reduction in renal blood flow.

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Author information

Authors and Affiliations

  1. Howard Florey Institute, University of Melbourne, 3010, Parkville, VIC, Australia

    David Di Giantomasso & Clive N. May

  2. Department of Intensive Care and Department of Surgery, Austin Hospital, Heidelberg, Melbourne, Australia

    Rinaldo Bellomo

Authors
  1. David Di Giantomasso
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  2. Rinaldo Bellomo
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  3. Clive N. May
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Corresponding author

Correspondence to Clive N. May.

Additional information

This study was supported by an institute grant (no. 983001) from the National Health & Medical Research Council of Australia and by grants from the Intensive Care Foundation of the Australian and New Zealand Intensive Care Society, the Laerdal Foundation (Norway) and the ARMC Anaesthesia and Intensive Care Trust Fund.

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Di Giantomasso, D., Bellomo, R. & May, C.N. The haemodynamic and metabolic effects of epinephrine in experimental hyperdynamic septic shock. Intensive Care Med 31, 454–462 (2005). https://doi.org/10.1007/s00134-005-2580-x

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  • DOI: https://doi.org/10.1007/s00134-005-2580-x

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