Prostacyclin in Septic Shock: Methods

In a prospective, single cohort design, we studied 15 patients in large tertiary-care ICU. All procedures were approved by our institutional research review committee and informed consent was received. Clinical data of the patients are shown in Table 1. All required ventilatory support and pulmonary artery catheterization due to septic shock. Patients exhibited at least five of the following clinical criteria of septic shock: persistent arterial hypotension with a systolic blood pressure <90 mm Hg, increasing volume need (>4 L of fluid per 24 h), systemic vascular resistance <700 dynesXsXcm’, temperature above 38.5°C or below 35.0°C, white blood cell count above 12X109 or below 4X109 cells per liter, either positive blood culture or a known site of sepsis, decrease of the thrombocytes >30 percent/24 h not due to bleeding, tachypnea, or mental disturbances with agitation and confusion.

All patients were deeply sedated with continuous infusions of fentanyl (maximal dosage: 0.24 mg/h) and dehydrobenzperidol (maximal dosage, 3.0 mg/h). Buy proventil More info Standardized sedation and analgesia was considered essential to avoid physiologic increase in V02 by pain, agitation, or awakening. Mechanical ventilation was accomplished with a volume-cycled machine (Siemens Servo 900 B) at tidal volumes of 12 to 15 ml/kg of body weight, an inspiratory: expiratory ratio of 1:2, positive end-expiratory pressure as clinically indicated (maximally 12 cm H2O), and a constant FI02 during the study period. All patients were studied within 24 to 36 h after the diagnosis of septic shock was confirmed. Table 2 shows grouped clinical data on the patients. The severity of illness in the 24 h immediately preceeding the study was assessed according to the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system.

Table 1—Clinical Data on 15 Patients with Septic Shock

Pat. No./Sex/ Age, yr Underlying Diagnosis Septic Focus FIo2 PEEP, cm H2O Dob,Mg/kg/min Nor,Mg/kg/min Outcome
l/F/66 Brain tumor Pneumonia 0.30 +5 6.0 0.30 Died
2/F/22 Brain tumor Pneumonia 0.35 + 12 9.7 0.35 Survived
3/F/30 Perforation of the small intestine Peritonitis 0.35 +8 8.3 0.30 Died
4/M/34 Ulcerative colitismultiple perforations Peritonitis 0.35 + 10 6.0 0.15 Died
5/M/39 Multiple injuries Infection of the amputation stump 0.50 + 10 4.6 0.6 Died
6/F/72 Perforation of the large intestine Peritonitis 0.30 +6 14.0 0.30 Survived
7/M/81 Upside-down stomach, perforation Peritonitis 0.30 +9 13.0 0.30 Died
8/M/36 Liquor fistula Meningitis 0.35 + 10 14.5 0.10 Died
9/F/55 Cancer of the kidney Pneumonia 0.40 + 10 10.4 Died
10/M/65 Infection of avascular prosthesis Pneumonia 0.35 + 10 13.8 0.19 Died
ll/F/70 Perforation of the small intestine Pneumonia 0.30 +6 13.8 Died
12/M/68 Multiple injuries Pneumonia 0.33 + 10 11.8 1.40 Died
13/F/55 Brain injury Pneumonia 0.30 + 10 18.1 0.04 Died
14/F/35 Cancer of the large intestine, perforation Peritonitis 0.50 + 10 14.4 0.17 Died
15/M/72 Multiple injuries Pneumonia 0.30 + 10 15.6 0.22 Died

Table 2—Clinical Data on 15 Patients with Septic Shock (Means ± SD)

Factor Value
Sex, M:F 7:8
Age, yr 53 ±19
APACHE II score, 24 h before study 18±7
Level of PEEP for arterial oxygenation, cm H2O 9.1 ±1.9
Dobutamine administration 15
No. of patients.
Dosage for hemodynamic stability, Mg/kg/min 11.6±4.0
Range (4.6 to 18.1)
Norepinephrine administration
No. of patients 13
Dosage for hemodynamic stability, Mg/kg/min 0.30 ±0.35
Range (0.04 to 1.40)
Time from study to discharge from ICU or death, days
Survivors (n=2) 65±78
Nonsurvivors (n=13) 15 ±10
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