Association between cytokines, nitric oxide, hemodynamic and microcirculation in a porcine model of sepsis

Systemic inflammation and hemodynamic or microvascular alterations are a hallmark of sepsis and play a role in organs hypoperfusion and dysfunction. Pimobendan, an inodilator agent, could be an interesting option for inotropic support and microcirculation preservation during shock. The objectives of this study were to evaluate effect of pimobendan on cytokine and nitric oxide (NO) release and investigate whether changes of macro and microcirculation parameters are associated with the release of cytokines and NO in pigs sepsis model. After circulatory failure, induced by intravenous inoculation of live Pseudomonas aeruginosa, eight animals were treated with pimobendan and eight with placebo. Pimobendan did not affect cytokines secretion (TNF-alpha, IL-6 and IL-10), but decreased time-dependently NO release. Data of macro and microcirculation parameters, NO and TNF- alpha recorded at the time of circulatory failure (T hypotension ) and the time maximum of production cytokines was used for analyses. A positive correlation was observed between TNF-alpha and cardiac index (r r = 0.55, p = 0.03) and a negative with systemic vascular resistance (r r =-0.52, p = 0.04). Positive correlations were seen both between IL-10, 30 min after resuscitation (T 30min ), and systolic arterial pressure (r r = 0.57, p = 0.03) and cardiac index (r r = 0.67, p = 0.01), and also between IL-6, taken 2 h after resuscitation and systolic arterial pressure (r r = 0.53, p = 0.04). Negative correlations were found between IL-10 and lactate, measured resuscitation time (r r =-0.58, p = 0.03). Regarding microcirculation parameters, we observed a positive correlation between IL-6 and IL-10 with the microvascular flow index (r r = 0.52, p = 0.05; r = 0.84, p = 0.0003) and a negative correlation with the heterogeneity index with TNF-alpha and IL-10 (r r =-0.51, p = 0.05; r =-0.74, p = 0.003) respectively. NO derivatives showed a positive correlation with temperature gradient (r r = 0.54, p = 0.04). Pimobendan did not show anti-inflammatory effects in cytokines release. Our results also, suggest changes of macro- and microcirculation are associated mainly with low levels of IL-10 in sepsis.