Rove the oxygen delivery emand relationship, thereby limiting the increase in arterial lactate concentrations in

Rove the oxygen delivery emand relationship, thereby limiting the increase in arterial lactate concentrations in ovine endotoxemia. Methods Fourteen adult ewes were instrumented for chronic hemodynamic monitoring. Following 16 hours of endotoxemia (Salmonella typhosa endotoxin, 10 ng/kg/min) the animals received either a continuous infusion of AM at incremental doses (10, 50, 100 ng/kg/min; each for 30 min) or the vehicle (normal saline; n = 7 each). Results Endotoxin infusion contributed to a hypotensive?hyperdynamic circulation characterized by decreases in mean arterial pressure (MAP) and systemic vascular resistance index as well as increases in heart rate (HR), cardiac index (CI) and arterial lactate concentrations. AM infusion at 100 ng/kg/min increased the CI (12.2 ?0.8 vs 7.8 ?0.5 l/min) and oxygen delivery index (1,734 ?121 vs 1,075 ?63 ml/min/m2), thereby decreasing the arterial lactate concentration (0.7 ?0.2 vs 1.7 ?0.3 mg/dl) and mean pulmonary arterial pressure (18 ?1 PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20799856 vs 24 ?1 mmHg; each P < 0.001 vs control) noticed in the control group. However, AM infusion at 100 ng/kg/min was linked to a decrease in MAP (64 ?2 vs 80 ?4 mmHg, P < 0.001 vs control). Conclusions Despite decreasing MAP, infusion of AM reversed pulmonary hypertension and improved the oxygen supply emand THK5351 (R enantiomer) relationship in a dose-dependent manner, as indicated by a reduced arterial lactate concentration. However, due to the vasodilatory properties of AM, it may be rationale to combine AM with a vasopressor agent.P11 Angiopoietin-2 correlates with pulmonary capillary permeability and disease severity in critically ill patientsM van der Heijden1, V van Hinsbergh2, G van Nieuw Amerongen2, P Koolwijk2, R Musters2, J Groeneveld1 1VU University Medical Center, Amsterdam, The Netherlands; 2Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands Critical Care 2007, 11(Suppl 2):P11 (doi: 10.1186/cc5171) Introduction It has previously been shown that angiopoietin-1 (Ang1) protects the adult vasculature against plasma leakage, whereas Ang2 and VEGF destabilize the vascular endothelium resulting in vascular leakage. Consequently they might be involved in the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in sepsis patients. We hypothesized that plasma Ang2 levels are associated with pulmonary capillary protein permeability, the lung injury score (LIS), length of stay on the ICU, the APACHE II score and survival in septic patients with ALI or ARDS. Methods A prospective observational study was performed in an ICU of an university hospital on 112 patients: 38 after elective cardiac surgery, 26 after major vascular surgery, 24 with sepsis and 24 with trauma. Plasma levels of Ang1, Ang2 and VEGF were measured and a mobile probe system was used to measure the pulmonary leak index (PLI) (that is, the transvascular transport rate of gallium-67-radiolabeled transferrin). Results Plasma levels of Ang2 and the PLI were significantly higher in patients with sepsis compared with other patient groups. In the sepsis group, a positive linear correlation was observed between plasma levels of Ang2 and length of stay on the ICU (rs = 0.509, P < 0.05) as index for disease severity. For all patients together, Ang2 had a positive linear correlation with PLI (rs = 0.374, P < 0.01), LIS (rs = 0.489, P < 0.01) and APACHE II score (rs = 0.287, P < 0.01). Furthermore, Ang2 was significantly increasedP10 Exogenous adr.