Prostacyclin in Septic Shock: Therapy

The primary finding of this study was that in patients with septic shock with supranormal O2 delivery, prostacyclin infusion produced a modest further increase in D02 without a matching increase in V02. In fact, when V02 was measured independent of the D02, now considered by some to be preferable in studies comparing these two variables, there was no increase in V02 at all. These findings are in contrast to recent studies that have shown a “pathological” increase in V02 with a prostacyclin-induced increase in D02 in patients with respiratory distress, particularly those who subsequently died. Altogether, however, the total number of such patients studied with prostacyclin remains quite small. Furthermore, the present data address two key issues: methodologic coupling of data and the maintenance of above-normal levels of D02 in patients with septic shock.
Our findings of slightly higher V02 by indirect calculations than by direct respiratory gas exchange support the argument that there is some coupling of the shared variables cardiac output and arterial oxygen content, and overestimation of V02, by the indirect method. However, the fact that direct comparison of the V02 values obtained by the two methods did not reveal a significant difference suggests that the practical difference between the methods is small. Buy inhalers online other The difference we found in the two methods was in the same direction as reported previously.’ We did not attempt to use the gas exchange method in patients with FI02 >0.50 because we were not confident of its reliability in that range. One advantage of the respiratory gas method is that it averages the conditions over a much longer period of time, usually 1 to 5 min, rather than the discrete point in time of a few heartbeats of the cardiovascular equations. Interestingly, in each study mentioned above in which there were signs of V02 increasing with prostacyclin infusion,’ it was always calculated by the indirect method.

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