Evolution of lactate/pyruvate and arterial ketone body ratios in the early course of catecholamine-treated septic shock.

Objectives: To measure arterial lactate/pyruvate (L/P) and arterial ketone body ratios as reflection of cytoplasmic and mitochondrial redox state at different stages of catecholamine-treated septic shock and compare them with normal and pathologic values obtained in patients in shock who have decreased oxygen transport (cardiogenic shock), and to assess the relationship between the time course of lactate, L/P ratio, and mortality in septic shock.

Design: Prospective, observational human study.

Setting: A university intensive care unit.

Dobutamine improves the adequacy of gastric mucosal perfusion in epinephrine-treated septic shock.

Objective: To assess the effects of dobutamine at a rate of 5 micrograms/kg/min on hemodynamics and gastric intramucosal acidosis in patients with hyperdynamic septic shock treated with epinephrine.

Design: A prospective, interventional, clinical trial.

Setting: An adult, 16-bed medical/surgical intensive care unit of a university hospital.