Document Detail

Augmented venous return: a model of left ventricular afterload reduction during the course of endotoxin shock.
MedLine Citation:
PMID:  7023737     Owner:  NLM     Status:  MEDLINE    
Utilizing a canine model of endotoxin shock (E coli, 4 mg/kg, B6:026) the major determinants of cardiac output (preload, afterload, contractility, and heart rate) were simultaneously followed for 5 hr in four study groups: Group I: time-matched controls, Group II: endotoxin shock, Group III: endotoxin shock and femoral-femoral A-V shunt, and Group IV: A-V shunt control. Groups II and III demonstrated an initial, abrupt increase in total peripheral resistance (TPR), coronary vascular resistance (CVR), and pulmonary vascular resistance (PVR), and a decrease in cardiac output (CO), coronary flow (CF) and heart rate (HR) and stroke work (P less than 0.05). Group II then demonstrated a decrease in TPR, CVR, PVR with an increase in CO and CF but systemic arterial pressure did not return to control values. At approximately 3 hr, Group II developed a progressive increase in TPR, CVR, and PVR, and a decrease in CO, CF, and SW. Heart rate did not change. In contrast, at 3 hr Group III demonstrated no significant increase in TPR, CVR, or PVR, a progressive increase of CO and CF, and preservation of SW. It is hypothesized that endotoxin shock is characterized by an initial phase characterized by an increase in resistance and decrease in flow that is not affected by an augmented venous return. However, in the intermediate and latter stages of shock, there is a progressive increase in resistance and decrease in flow, increasing impedance to left ventricular ejection that results in an imbalance between myocardial oxygen supply and demand, contributing to the observed myocardial failure. An augmented venous return, by decreasing resistance (afterload) and increasing venous return (preload) preserves cardiac output and myocardial function and thus serves as a model of left ventricular afterload reduction during the course of endotoxin shock.
M L Hess; S M Krause; P Komwatana; R Eaton; E Okabe
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulatory shock     Volume:  8     ISSN:  0092-6213     ISO Abbreviation:  Circ. Shock     Publication Date:  1981  
Date Detail:
Created Date:  1981-11-22     Completed Date:  1981-11-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0414112     Medline TA:  Circ Shock     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  435-50     Citation Subset:  IM    
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MeSH Terms
Arteriovenous Shunt, Surgical
Cardiac Output
Coronary Circulation
Escherichia coli Infections / physiopathology*
Femoral Artery / surgery
Femoral Vein / surgery
Heart Rate
Models, Cardiovascular*
Shock, Septic / physiopathology*
Vascular Resistance
Venous Pressure
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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