Early in the development of sepsis, the combined cardiopulmonary and peripheral effects result in a decreased blood pressure, reduced ability to maintain blood pressure in the periphery and normal to increased blood pumped out of the heart. In non-survivors, end-stage septic shock is characterized by a low blood pressure and a reduced ability to pump blood out of the heart resulting in multiple organ system failure and death. The inability to resolve the heart dysfunction and maintain adequate blood flow to the organs is the most significant contributing factor to the demise of the patient. Treatment of patients with sepsis consists of giving fluids and vasopressors to maintain blood pressure while giving antibiotics to kill the bacteria. At present, the canine model of sepsis uses a bacterial clot and is treated with fluids and antibiotics (15). The purpose of this study is to determine the number of animals necessary to determine the dose of epinephrine that will maintain blood pressure during sepsis and if this will have a beneficial effect on outcome. The use of epinephrine should allow us to more accurately characterize the treatment of sepsis in humans and address the low blood pressure and cardiac output. The results of this study have shown that epinephrine, compared to norepinephrine and vasopressin, adversely affects survival rate despite titration to produce appropriate effects on MAP.
| Solomon, Steven B; Banks, Steven M; Gerstenberger, Eric et al. (2003) Sympathetic blockade in a canine model of gram-negative bacterial peritonitis. Shock 19:215-22 |
