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Septic Shock: Hemodynamic Cost of Inflammation

Robert W. Hopkins, MD
Arch Surg. 1970;101(2):298-307. doi:10.1001/archsurg.1970.01340260202030.
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To evaluate the hemodynamic "cost" of inflammation and effects on the hyperemia of drugs used in the treatment of shock, inflammatory lesions were created in anesthetized dogs by the infection of 10% calcium chloride into one thigh. Compared to the normal limb four days later, iliac arterial blood flow to the inflamed limb was 123% greater, iliac arteriovenous oxygen difference 47% less, and oxygen consumption 23% greater. With norepinephrine levarterenol 0.56μg/kg/min, the blood flow fell and vascular resistance and arteriovenous oxygen difference rose in the inflamed limb but not in the normal limb. Effects of norepinephrine were inhibited by phenoxybenzamine hydrochloride and phentolamine hydrochloride. Effects of methylprednisolone (10 mg/kg) were minimal. The findings indicate that inflammation increases hemodynamic requirements in excess of metabolic requirements. The active hyperemia is reduced by α-adrenergic stimulation but not by steroids.


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