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β‐Blockade attenuates renal blood flow in experimental endotoxic shock by reducing perfusion pressure

Authors: Gerard A. Rongen; Joris Lemson; Lex M. van Loon; Lex M. van Loon; Johannes G. van der Hoeven; Peter H. Veltink;

β‐Blockade attenuates renal blood flow in experimental endotoxic shock by reducing perfusion pressure

Abstract

Clinical data suggests that heart rate (HR) control with selective β1-blockers may improve cardiac function during septic shock. However, it seems counterintuitive to start β-blocker infusion in a shock state when organ blood flow is already low or insufficient. Therefore, we studied the effects of HR control with esmolol, an ultrashort- acting β1-selective adrenoceptor antagonist, on renal blood flow (RBF) and renal autoregulation during early septic shock. In 10 healthy sheep, sepsis was induced by continuous i.v. administration of lipopolysaccharide, while maintained under anesthesia and mechanically ventilated. After successful resuscitation of the septic shock with fluids and vasoactive drugs, esmolol was infused to reduce HR with 30% and was stopped 30-min after reaching this target. Arterial and venous pressures, and RBF were recorded continuously. Renal autoregulation was evaluated by the response in RBF to renal perfusion pressure (RPP) in both the time domain and frequency domain. During septic shock, β-blockade with esmolol significantly increased the pressure dependency of RBF to RPP. Stopping esmolol showed the reversibility of the impaired renal autoregulation. Showing that clinical diligence and caution are necessary when treating septic shock with esmolol in the acute phase since esmolol reduced RPP to critical values thereby significantly reducing RBF.

Country
Netherlands
Keywords

Lipopolysaccharides, Physiology, Adrenergic beta-Antagonists, beta‐blocker, Pharmacology-Toxicology - Radboud University Medical Center, Renal Circulation, sepsis, Propanolamines, Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences, Heart Rate, QP1-981, Animals, Internal Medicine - Radboud University Medical Center, Infusions, Intravenous, Original Research, Sheep, Intensive Care - Radboud University Medical Center, renal autoregulation, renal blood flow, Acute Kidney Injury, Shock, Septic, acute kidney injury, beta-blocker, Female, Radboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
2
Average
Average
Average
Green
gold