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Vol. 35. Issue 2.
Pages 84-91 (January 2011)
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Vol. 35. Issue 2.
Pages 84-91 (January 2011)
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Development of a septic shock experimental model oriented at training. Application in the training of depuration techniques in the management of severe sepsis
Desarrollo de un modelo experimental de shock séptico orientado a la formación. Aplicación en el entrenamiento de técnicas de depuración en el manejo de la sepsis grave
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M.E. Herrera-Gutiérreza,ast;
Corresponding author
mehguci@gmail.com

Corresponding author.
, G. Seller-Péreza, G. Quesada Garcíaa, M.M. Granadosb, J.M. Domínguezb, R.J. Gómez-Villamandosb
a Cuidados Críticos y urgencias, Hospital Universitario Carlos Haya, Málaga, Spain
b Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain
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Abstract
Objective

To define a septic shock experimental model that can be used in for training in the early management of septic shock, specifically by extracorporeal depuration (ECD).

Design

A case-control experimental study.

Setting

Veterinary university hospital.

Subjects

Ten Beagle dogs (weight 12–15kg).

Interventions

Shock was induced using 1mg/kg Escherichia coli lipopolysaccharide (LPS) diluted in 20mL saline infused in 10minutes, with a subsequent follow-up at 6hours. There was no intervention in 5 animals in order to define the natural course of the shock and 5 underwent high volume hemofiltration (HVHF, 100mL/kg/h) to define delay in response to treatment.

Variables

Pressures (arterial and pulmonary), hemodynamic parameters, gastric tonometry and respiratory function were recorded.

Results

The LPS effect was evidenced at 2minutes of the infusion and the 10 animals showed severe shock at the end of the infusion. At 2-hours, changes between treated and non-treated animals were seen in cardiac output, systolic volume variability and mucous CO2. Mean arterial pressure was significantly different at four hours. All non-treated subjects died during the 6-hour follow-up and all the treated animals survived for this period. Based on these results, we developed a workshop that has been used in five courses (www.ccmijesususon.com-www.crrtcordoba.com.es/), obtaining the previous results.

Conclusions

Our shock model shows a predictable behavior, very short latency and a sufficiently rapid improvement in the treated animals for it to be applied in training workshops. It is useful for training in the high-volume hemofilitration (HVHF) and can be used for training in the early management of septic shock.

Keywords:
Septic shock
Extracorporeal depuration
Animal research
Resumen
Objetivo

Definir un modelo experimental de shock séptico que pueda aplicarse al entrenamiento en el manejo inicial del shock séptico, de forma concreta mediante el uso de técnicas de depuración extrarrenal (TDE).

Diseño

Estudio experimental de casos-control.

Ámbito

Hospital veterinario universitario.

Sujetos

Diez perros Beagle (peso 12–15kg).

Intervenciones

Se provocó shock infundiendo 1mg/kg de lipopolisacárido de Escherichia coli (LPS) en 20ml salino en 10min, con un seguimiento posterior de 6h. Cinco animales no recibieron intervención para definir el curso del shock y 5 fueron tratados con hemofiltración de alto volumen (HVHF, 100ml/kg/h) para valorar la rapidez de respuesta.

Variables de interés

Se monitorizaron presiones (arterial y pulmonar), parámetros hemodinámicos, tonometría gástrica y función respiratoria.

Resultados

A los 2min el efecto de la infusión de LPS era apreciable y al final de la infusión los 10 animales mostraban shock severo. A las 2h se apreciaban diferencias en gasto cardíaco, variabilidad de volumen sistólico y CO2 mucoso entre tratados y no tratados. En 4h la diferencia era evidente también en presión arterial media. Ningún control y todos los tratados sobrevivieron las 6h del experimento. Posteriormente, hemos desarrollado un taller docente basado en este protocolo que se ha aplicado en cinco cursos de formación (www.ccmijesususon.com; www.crrtcordoba.com.es/), obteniendo los resultados previstos.

Conclusiones

Este modelo de shock muestra una respuesta predecible en el tiempo, una latencia muy corta y una mejoría en animales tratados suficientemente rápida como para aplicarlo en talleres de formación. Es útil para el entrenamiento en HVHF y, asimismo, podría aplicarse en otros escenarios de manejo precoz del shock séptico.

Palabras clave:
Shock séptico
Depuración extracorpórea
Experimentación animal
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Copyright © 2011. Elsevier y Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias
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Medicina Intensiva (English Edition)
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