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Session: Poster session I
Session starts: Thursday 24 January, 15:00

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L.M. van Loon (University of Twente)

Abstract:
Introduction: Heart rate (HR) control with esmolol could benefit central hemodynamics during septic shock, but might reduce organ perfusion by reducing perfusion pressure. We assessed the effect of HR control with esmolol on renal blood flow during early sepsis. Method: Sepsis was induced in 10 healthy anesthetized and mechanically ventilated sheep by continuous IV-administration of lipopolysaccharide. After successful resuscitation of the septic shock with fluids and vasoactive drugs, esmolol was infused to reduce HR but stopped 30-min after reaching a targeted HR reduction of 30%. Arterial and venous pressures, and renal blood flow (RBF) were recorded continuously. Results: Renal perfusion pressure (RPP) - i.e. arterial minus venous pressure - was not significantly altered during resuscitated septic shock while beta-blockade with esmolol significantly reduced both RPP and RBF. Positive correlations were found between RPP and RBF. This correlation was weaker when RPP was above 70% of baseline, with RBF displaying a relative ‘plateau’ above this threshold. Esmolol increased the lower limit of renal autoregulation. This resulted in the disappearance of the physiological ‘plateau’ and returned after stopping esmolol. Showing the reversibility of these effects. Conclusion: In our experimental animal model, renal autoregulation remained preserved despite acute endotoxic shock. Nevertheless, during the subsequent strong beta-blockade with esmolol the lower limit of autoregulation was increased and RBF was significantly reduced as a consequence of a low RPP.