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actor (TNF),
interleukin (IL) 1, IL-2, IL-6, and interferon gamma (IFG) serially for the
first 48 h following the onset of hypotension (systolic blood pressure < 90 mm
Hg) thought likely to be due to sepsis in all patients presenting to one ICU.
These data were correlated with initial severity of shock and retrospective
determination of septic or nonseptic origin, preexistent hepatic cirrhosis,
subsequent development of MSOF, and outcome.
RESULTS: Fifty-three specific episodes of shock in 52 patients were recorded
(35 septic and 18 nonseptic episodes). Mortality was higher in septic patients
(41 vs 17 percent, p < 0.01), as was the development of MSOF (29 vs 6 percent,
p < 0.001), incidence of cirrhosis (21 vs 0 percent, p < 0.01), and TNF levels
over the study interval (p < 0.01). Nonseptic patients also had an initial
elevation in TNF over 48-h levels (p < 0.05) that were higher than serum
levels reported for normal subjects (chi 2, p < 0.05). There was no relation
between peak TNF level and outcome. Sixty-seven percent of the cirrhotic
patients had development of MSOF and died, while only 30 percent of the
noncirrhotic patients had development of MSOF or died (p < 0.05). The TNF and
IL-6 levels in patients who had MSOF or who died were both elevated and did
not decrease over time independent of presence or absence of sepsis (p <
0.01). Similarly, IL-6 levels after 12 h were higher in cirrhotic patients
than in noncirrhotic septic patients (p < 0.05). No elevation in IL-1, IL-2,
or IFG was seen in any patient subpopulation.
CONCLUSIONS: TNF and IL-6 serum levels are higher in septic than in nonseptic
shock, but the persistence of TNF and IL-6 in the serum rather than peak
levels of cytokines predicts a poor outcome in patients with shock.
Address: Department of Anesthesiology and Critical Care Medicine, University
of Pittsburgh.
UI: 93161763
Title: Efficacy and safety of naloxone in septic shock
Journal: Crit Care Med 13:28-33, 1985
Publication Date: 1985 Jan
Author(s): Rock P, Silverman H, Plump D, Kecala Z, Smith P, Michael JR, Summer
W
Abstract: We evaluated the effectiveness and safety of iv naloxone in 12
septic patients who remained hypotensive despite volume replacement,
appropriate antibiotics, and vasopressor therapy. Only four patients responded
positively to naloxone, by increases in mean arterial pressure of between 10
to 15 mm Hg that lasted for 15 to 60 min. These patients could not be
distinguished from the others on the basis of underlying illness, laboratory
or physical findings, length of preceding hypotension, or glucocorticoid
therapy. Four patients had adverse reactions: one developed pulmonary edema,
one patient had a grand-mal seizure, and two patients became severely
hypotensive. We conclude that in patients with well-established septic shock,
naloxone does not reliably improve mean arterial pressure or other physiologic
variables, and may cause severe adverse reactions.
UI: 85075695

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