Document Detail


Continuous hemofiltration in pigs with hyperdynamic septic shock affects cardiac repolarization.
MedLine Citation:
PMID:  18936693     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Sepsis has been defined as the systemic host response to infection with an overwhelming systemic production of both proinflammatory and anti-inflammatory mediators. Continuous hemofiltration has been suggested as possible therapeutic option that may remove the inflammatory mediators. However, hemodialysis and hemofiltration were reported to influence cardiac electrophysiologic parameters and to increase the arrhythmogenic risk. We hypothesize that sepsis affects electrophysiologic properties of the pig heart and that the effects of sepsis are modified by hemofiltration. DESIGN: Laboratory animal experiments. SETTING: Animal research laboratory at university medical school. SUBJECTS: Forty domestic pigs of either gender. INTERVENTIONS: In anesthetized, mechanically ventilated, and instrumented pigs sepsis was induced by fecal peritonitis and continued for 22 hours. Conventional or high-volume hemofiltration was applied for the last 10 hours of this period. MEASUREMENTS AND MAIN RESULTS: Electrocardiogram was recorded before and 22 hours after induction of peritonitis. RR, QT, and QTc intervals were significantly shortened by sepsis. The plasma levels of interleukin-6 and tumor necrosis factor-alpha were increased in sepsis. High-volume hemofiltration blunted the sepsis-induced increase in tumor necrosis factor-alpha. Action potentials were recorded in isolated ventricular tissues obtained at the end of in vivo experiments. Action potential durations were significantly shortened in septic preparations at all stimulation cycle lengths tested. Both conventional and high-volume hemofiltrations lead to further shortening of action potential durations measured afterward in vitro. This action potential duration shortening was reversed by septic hemofiltrates obtained previously by conventional or high-volume hemofiltration. Tumor necrosis factor-alpha (500 ng/L) had no effect on action potential durations in vitro. CONCLUSIONS: In a clinically relevant porcine model of hyperdynamic septic shock, both sepsis and continuous hemofiltration shortened duration of cardiac repolarization. The continuous hemofiltration was not associated with an increased prevalence of ventricular arrhythmias. Tumor necrosis factor-alpha or interleukin-6 did not contribute to the observed changes in action potential durations.
Authors:
Milan Stengl; Roman Sykora; Ales Krouzecky; Jiri Chvojka; Ivan Novak; Veronika Varnerova; Jitka Kuncova; Lukas Nalos; Jitka Sviglerova; Martin Matejovic
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  36     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2008-12-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3198-204     Citation Subset:  AIM; IM    
Affiliation:
Department of Physiology, Charles University in Prague, Faculty of Medicine and Teaching Hospital in Plzen, Plzen, Czech Republic. milan.stengl@lfp.cuni.cz
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MeSH Terms
Descriptor/Qualifier:
Action Potentials
Animals
Arrhythmias, Cardiac / physiopathology,  prevention & control
Disease Models, Animal
Electrocardiography
Female
Heart / physiopathology*
Hemodynamics
Hemofiltration*
Interleukin-6 / biosynthesis
Male
Respiration, Artificial
Shock, Septic / metabolism,  physiopathology*,  therapy*
Sus scrofa
Tumor Necrosis Factor-alpha / biosynthesis
Ventricular Function
Chemical
Reg. No./Substance:
0/Interleukin-6; 0/Tumor Necrosis Factor-alpha
Comments/Corrections
Comment In:
Crit Care Med. 2008 Dec;36(12):3272-3   [PMID:  19020441 ]

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


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