A Circulating Myocardial Depressant Substance is Associated with Cardiac Dysfunction and Peripheral Hypoperfusion: Cardiovascular function

In: Septic Shock

10 Nov 2014

In addition to cardiovascular function, this study investigates a possible association between MDS posi-tivity and a variety of laboratory parameters and measures of organ function. The only laboratory parameter that distinguished between patients with and without MDS was a significantly higher mean peak lactic acid level in the group with MDS. Several possible pathophysiologic mechanisms that might explain the association of MDS with higher levels of lactic acid are: (1) a more pronounced decrease in cardiac output might occur relative to tissue needs in the group of patients with MDS. This would cause greater tissue hypoperfusion and thus higher lactic acid levels. buy asthma inhalers online

Our data do not support this hypothesis, since mean values for cardiac outputs and mixed venous oxygen contents were not different between MDS positive and negative groups. (2) MDS might cause more pronounced shunting of blood peripherally, thereby elevating lactic acid. Our data do not support this hypothesis either, since mean mixed venous oxygen content was similar in the two groups. (3) The degree of tissue hypoperfusion (due to a number of possible mechanisms) might be more severe in patients with MDS, thereby increasing lactic acid levels. Our data show that a trend toward more severe shock exists in the MDS positive group: they were less likely to have fluid-responsive septic shock (three of 14 vs 11 of 20, 0.05<p<0.10), they required higher levels (though not significantly higher) of exogenous catecholamines (dopamine and levarterenol), and they had a trend toward a higher mortality (five of 14 vs two of 20, 0.05<p<0.10). The association between MDS and elevated lactic acid suggests that a significant peripheral vascular abnormality is linked to circulating MDS in human septic shock. Further studies are needed to define the mechanism of the elevated lactic acid level in MDS positive patients with septic shock.

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